Candidaemia in a European Paediatric University Hospital: a 10-year observational study

Abstract

In this retrospective observational study covering 1998 to 2008, 32 patients (mean age: 7.50 years) were identified that had 35 episodes of candidaemia (0.47 cases/1000 hospital discharges). Cancer/allogeneic haematopoietic stem cell transplantation (43%) and congenital malformations/syndromes (21%) were the predominant underlying conditions. Central venous catheterization (90%), a history of antibacterial therapy (69%) and previous bacteraemia (54%) were frequent comorbidities. Candida albicans (46%) was most common, followed by Candida parapsilosis (17%) and Candida glabrata (14%). Resistance was infrequent and limited to non-albicans Candida spp. The 30-day and 100-day mortality rates were 11.4%.

Clinical and molecular characteristics of bloodstream infections caused by Candida albicans in children from 2003 to 2011

“…It is noticeable that the children with C. albicans BSI M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 14 in the present study almost had previous antibiotic exposure, long-term hospitalization, or a catheter or artificial device in place. These findings are consistent with those previously reported, in which retained intravascular catheters, intestinal failure, presence of gastrostomy tube, and/or receipt of TPN were identified as independent risk factors of candidemia [5,8,11,12,36].…”

“…Risk factors for children with candidemia include intravenous catheter placement with parenteral nutrition, abdominal surgery, steroid usage and exposure to broad-spectrum antibiotics [11][12][13][14][15].…”

Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia

“…However, antifungal resistance cannot explain the significantly higher rate of persistent fungemia after effective antifungal therapy 9, 18, 41 . Additionally, our cohort had higher rates of retained CVC when compared with other studies 18, 41 , which may be due to more patients had severe sepsis and septic shock and early CVC removal was not possible.…”

“…The incidence of candidemia varies from 24 to 32.3 episodes/per 10,000 admissions 1, 3, 4 , and the mortality rate was 22–60% 2–6 . Recent strategies of antifungal prophylaxis or preemptive therapy for selected high-risk patients account for emergence of fluconazole resistant strains and an increased prevalence of non- albicans Candida species 7–9 . The mortality rate of children with candidemia remains high 10, 11 , and most patients have severe medical illness, surgical risk factors, presence of artificial devices, and frequently exposed to some high-risk medications 12–14 .…”

Different scenarios for Candida parapsilosis fungaemia reveal high numbers of mixed C. parapsilosis and Candida orthopsilosis infections

“…Due to the substantial morbidity and mortality associated with these infections it is clear that fungal diseases have emerged as important public health problems (Pfaller & Diekema, 2007). While Candida albicans remains the most common causative agent of candidaemia, the incidence of Candida parapsilosis has increased significantly, outranking C. albicans in some studies, depending on the period and geographical area (Aittakorpi et al, 2012;Lagrou et al, 2007;Lockhart et al, 2012;Maganti et al, 2011;Nucci et al, 2013;Parmeland et al, 2013;Tragiannidis et al, 2012;Wu et al, 2011;Xess et al, 2007). Candidaemia risk factors include the use of broad-spectrum antibiotics, cancer chemotherapy, immunosuppressive agents and indwelling medical devices (Tumbarello et al, 2007).…”