Đặc điểm lâm sàng, cận lâm sàng nhiễm nấm xâm lấn ở trẻ em tại khoa điều trị tích cực Bệnh viện Nhi Trung ương

Abstract

A retrospective study investigating the clinical and subclinical characteristics, as well as the diagnostic certainty level, of invasive fungal infection was conducted on 39 pediatric patients admitted to the PICU at the National Children’s Hospital between 2022 and 2023. The cohort was characterized by a high prevalence of classic risk factors, including prolonged PICU stay > 7 days (87.18%), use of broad-spectrum antibiotics (94.87%), and central venous catheterization (97.43%). Clinically, the majority of children presented with shock (82.06%) and the severity of illness, measured by the median PRISM III score, was high at 19 (IQR: 11 - 30). The median time to diagnosis was 6 days (IQR: 1 - 18 days). Notably, the proven diagnostic certainty level was achieved significantly later than the possible level (Median 12 days versus 5 days, respectively). While risk factors and clinical data showed no difference between diagnostic certainty levels (p > 0.05), higher rates of shock, median PRISM III score, and median CRP were observed in the mortality group (p < 0.05). Microbiologically, C. albicans was the most common isolate in the bloodstream (52.94%). Antifungal susceptibility testing revealed excellent sensitivity (100%) to Caspofungin, Micafungin and Flucytosine. Voriconazole was also 100% sensitive, while Fluconazole was 88.89% susceptible and 11.11% resistant. Amphotericin B demonstrated an 89.76% susceptibility rate, with cases of resistance (5.12%) and intermediate susceptibility (5.12%).