Abstract
BackgroundSurveillance of current changes in the epidemiology of Invasive Fungal Diseases (IFDs) as an important component of the antifungal stewardship programs (ASP), requires careful regular monitoring, especially in high-risk settings such as oncology centers. This study aimed to examine Candida colonization status and corresponding current changes in children with malignancy during repeated admissions and also investigate the possible epidemiological shifts after the implementation of ASP.MethodsIn this prospective observational study, all eligible patients younger than 18 years were recruited during 2016–2017 at Amir Medical Oncology Center (AMOC) in Shiraz, Iran. Totally, 136 patients were enrolled and 482 samples were collected from different sites (oral/nasal discharges, urine and stool). Weekly regular sampling was carried out during hospitalization. Candida colonization status and epidemiological changes were monitored during repeated admissions. Samples were cultivated on Sabouraud Dextrose agar medium and identified by Polymerase Chain Reaction -Restriction Fragment Length Polymorphism (PCR-RFLP).ResultsEstimated Candida colonization incidence was 59.9% (82/136) in our patients. Candida colonization was found to be higher in oral cavity and rectum than that in nasal cavity. Among those long-term follow ups and repetitive hospitalizations, a significant number of patients exhibited changes in their colonization patterns (37.7%). Candida colonization did not reveal any significant relationship with age, sex, oncologic diseases and degree of neutropenia. C. albicans (72.0%) was found as the most common Candida species in colonized patients, followed by C. krusei, C. kefyr, C. glabrata and C. parapsilosis.ConclusionGiven the high incidence of Candida infections in children with cancers, close monitoring of epidemiologic changes is essential for judicious management, based on local surveillance data and improvement of overall quality of care in high risk patients.
Highlights
Surveillance of current changes in the epidemiology of Invasive Fungal Diseases (IFDs) as an important component of the antifungal stewardship programs (ASP), requires careful regular monitoring, especially in high-risk settings such as oncology centers
This study seeks to investigate the epidemiology of Candida colonization and any possible changes in colonization pattern in children with malignancies as a part of regular local surveillance program in Amir Medical Oncology Center (AMOC) in Shiraz, Iran
The study was conducted in the continuation of the previous research carried out in 2011-2012 by Haddadi et al [18] to investigate the epidemiology of candida colonization and its possible changes during recurrent admissions in AMOC
Summary
Surveillance of current changes in the epidemiology of Invasive Fungal Diseases (IFDs) as an important component of the antifungal stewardship programs (ASP), requires careful regular monitoring, especially in high-risk settings such as oncology centers. Changes in colonization may happen during repeated admissions and various risk factors may make children with hematological malignancies prone to new colonization (especially resistance ones), multi-species colonization or changed primary colonization [11] Some of these possible risk factors may be broad-spectrum antibiotic therapy, antifungal prophylaxis, Azole antifungal misuse, various types of short/long term indwelling catheters, total parenteral nutrition, neutropenia, surgical interventions, changes in chemotherapy intensity due to refractory disease or relapse, younger age at oncologic diagnosis, repeated IFDs during course of treatment and comorbidities such as hyperglycemia [11,12,13,14,15]. The study was conducted in the continuation of the previous research carried out in 2011-2012 by Haddadi et al [18] to investigate the epidemiology of candida colonization and its possible changes during recurrent admissions in AMOC
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