A carregar...
Publicação
Infeções fúngicas invasivas em idade pediátrica : casuística da Unidade de Cuidados Intensivos Pediátricos do HSM-CHLN entre 2008 e 2019
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1.02 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
As infeções fúngicas invasivas (IFI) constituem uma importante causa de morbilidade e mortalidade em crianças gravemente doentes. A implementação recente de novos instrumentos diagnósticos e terapêuticos alterou a epidemiologia destas infeções, revelando-se assim importante reavaliar a incidência das IFI.
O presente trabalho visa caracterizar a epidemiologia das IFI em doentes pediátricos críticos internados na Unidade de Cuidados Intensivos Pediátricos (UCIPed) do Hospital de Santa Maria do Centro Hospitalar Universitário Lisboa Norte (HSM-CHLN) nos últimos doze anos.
Recolheram-se e trataram-se estatisticamente os dados dos doentes internados entre 2008 e 2019 (distinguido dois períodos: 2008-2013 e 2014-2019) com critérios de IFI possível, provável ou provada segundo as definições da European Organization for Research and Treatment of Cancer (EORTC) ou que, durante o internamento, estiveram a ser tratados para uma IFI; foram excluídas as infeções por Pneumocystis jirovecci.
Incluíram-se 46 casos, maioritariamente concentrados no segundo período do estudo (67%). As doenças hematológicas, hemato-oncológicas, tumores sólidos e imunodeficiências, classicamente reconhecidos como grupos de risco para IFI, representaram uma fatia importante dos diagnósticos primários (n=16; 35%). A administração de antibioticoterapia de largo espectro foi o fator de risco mais repetido (98%); realizou-se quimioprofilaxia antifúngica em 7 dos 46 casos (15%). Contabilizando todas as definições, o agente etiológico mais frequente foi Candida spp (76%), predominando as espécies não albicans (60%), seguida por Aspergillus spp (19,6%). Verificou-se um aumento importante da utilização de equinocandinas do primeiro para o segundo período do estudo. Verificaram-se 6 óbitos (13%), podendo a causa da morte ser atribuída, direta ou indiretamente, à IFI, em dois destes casos.
Os resultados apresentados enquadram-se nos dados publicados até à data sobre epidemiologia das IFI em doentes pediátricos críticos, podendo as principais diferenças ser explicadas por características da amostra em estudo.
Invasive fungal infections (IFI) are an important cause of morbidity and mortality in critically ill children. The development of new diagnostic and therapeutic instruments has affected these infections’ epidemiology, making it important that the incidence of IFI is duly updated. The present study aims to describe the epidemiology of IFIs in critical pediatric patients admitted to the Pediatric Intensive Care Unit (UCIPed) of Hospital de Santa Maria of Centro Hospitalar Universitário Lisboa Norte (HSM-CHLN) in the last twelve years. The data from patients hospitalized between 2008 and 2019 (first period 2008-2013 and second period 2014-2019) who met criteria for possible, probable or proven IFI according to the EORTC definitions (2019 update) or who, during hospitalization, were being treated for an IFI were collected and statistically treated; Pneumocystis jirovecci related infections were excluded. Forty-six cases were included, which concentrated mostly at the second period of the study (67%). Hematological diseases, hemato-oncological diseases, patients being treated for solid tumours and patients with immunodeficiencies, classically recognized as risk groups for IFI, represented an important share of the primary diagnoses found (35%). The administration of broad-spectrum antibiotic therapy was the most frequent risk factor (98%); antifungal chemoprophylaxis was administered in 7 of the 46 cases (15%). When taking account all IFI definitions, the most frequent etiologic agent was Candida spp (76%), with predominance of non-albicans species (60%), followed by Aspergillus spp (19.6%). There was a remarkable increase in the use of echinocandins from the first to the second period. There were 6 deaths (13%), and the cause of death can be attributed, directly or indirectly, to the IFI, in two of these cases. The results presented fit into the data published to date on the epidemiology of IFIs in critical pediatric patients, the main differences being explained by the characteristics of the study sample.
Invasive fungal infections (IFI) are an important cause of morbidity and mortality in critically ill children. The development of new diagnostic and therapeutic instruments has affected these infections’ epidemiology, making it important that the incidence of IFI is duly updated. The present study aims to describe the epidemiology of IFIs in critical pediatric patients admitted to the Pediatric Intensive Care Unit (UCIPed) of Hospital de Santa Maria of Centro Hospitalar Universitário Lisboa Norte (HSM-CHLN) in the last twelve years. The data from patients hospitalized between 2008 and 2019 (first period 2008-2013 and second period 2014-2019) who met criteria for possible, probable or proven IFI according to the EORTC definitions (2019 update) or who, during hospitalization, were being treated for an IFI were collected and statistically treated; Pneumocystis jirovecci related infections were excluded. Forty-six cases were included, which concentrated mostly at the second period of the study (67%). Hematological diseases, hemato-oncological diseases, patients being treated for solid tumours and patients with immunodeficiencies, classically recognized as risk groups for IFI, represented an important share of the primary diagnoses found (35%). The administration of broad-spectrum antibiotic therapy was the most frequent risk factor (98%); antifungal chemoprophylaxis was administered in 7 of the 46 cases (15%). When taking account all IFI definitions, the most frequent etiologic agent was Candida spp (76%), with predominance of non-albicans species (60%), followed by Aspergillus spp (19.6%). There was a remarkable increase in the use of echinocandins from the first to the second period. There were 6 deaths (13%), and the cause of death can be attributed, directly or indirectly, to the IFI, in two of these cases. The results presented fit into the data published to date on the epidemiology of IFIs in critical pediatric patients, the main differences being explained by the characteristics of the study sample.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Infeções fúngicas invasivas Candida spp Aspergillus spp Imunossupressão Pediatria