儿童癌症患者的口腔念珠菌感染与定植：危险因素、菌种分布及抗真菌药物敏感性

摘要(中文译文)

口腔念珠菌病是儿童癌症患者常见的机会性真菌感染，可导致严重的侵袭性感染。为有效管理和治疗口腔念珠菌病，解决危险因素、准确鉴定念珠菌菌种并提供合适的局部或全身抗真菌治疗至关重要。本研究纳入2024年4月至9月期间所有年龄≤18岁的癌症患者。进行了口腔检查并采集微生物拭子。采用传统方法和分子方法进行菌种鉴定。依据临床与实验室标准研究所指南，研究了六种常用药物的体外抗真菌活性。在102例儿童癌症患者中，39例（38.2%）培养阳性。在培养阳性的患者中，9例（23.1%）被诊断为口腔念珠菌病，而30例（76.9%）表现为口腔念珠菌定植。年龄或性别与口腔念珠菌病之间未发现统计学显著关联，而地塞米松和头孢他啶则显著相关。在获得的41株念珠菌分离株中，白念珠菌最常见（51.2%），其次为都柏林念珠菌（21.9%）、非洲念珠菌（12.1%）、热带念珠菌（7.3%）、光滑念珠菌（2.4%）、马克斯克鲁维酵母（2.4%）和库德里阿兹威毕赤酵母（2.4%）。两性霉素B和卡泊芬净对所有念珠菌分离株表现出最高的体外活性。氟康唑对白念珠菌的耐药率最高，为28.6%。本研究为儿童癌症患者口腔念珠菌定植和感染相关的危险因素、分子流行病学和抗真菌药敏模式提供了有价值的见解。它还强调了持续监测抗真菌药敏模式的重要性，以支持该人群的抗真菌管理措施。

Abstract

Oral candidiasis is a common opportunistic fungal infection in pediatric cancer patients, which can lead to severe invasive infections. To manage and treat oral candidiasis effectively, it is vital to address risk factors, accurately identify Candida species, and provide suitable topical or systemic antifungal therapy. This study included all patients aged ≤ 18 years with cancer from April to September 2024. Oral examinations were conducted along with the collection of microbial swabs. Species identification was performed using both conventional and molecular methods. The in vitro antifungal activity of six common agents was investigated using the Clinical & Laboratory Standards Institute guidelines. Of the 102 pediatric patients with cancer, 39 (38.2%) had positive cultures. Among those with a positive culture, 9 patients (23.1%) were diagnosed with oral candidiasis, while 30 (76.9%) exhibited oral Candida colonization. No statistically significant link was found between age or gender and oral candidiasis, while dexamethasone and ceftazidime were significantly associated. Among 41 obtained Candida isolates, C. albicans was the most common (51.2%), followed by C. dubliniensis (21.9%), C. africana (12.1%), C. tropicalis (7.3%), N. glabratus (2.4%), K. marxianus (2.4%), and P. kudriavzevii (2.4%). Amphotericin B and caspofungin demonstrated the highest in vitro activity against all Candida isolates. Fluconazole showed the highest resistance rate at 28.6% for C. albicans. This study provides valuable insights into risk factors, molecular epidemiology, and antifungal susceptibility patterns associated with oral Candida colonization and infection in pediatric cancer patients. It also underscores the importance of continued surveillance of antifungal susceptibility patterns to support antifungal stewardship efforts in this population.

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