Candidemia in Children

Abstract

Background: Candida species are the most common cause of systemic fungal infections in children. Risk factors for candidemia vary in different patient populations, posing challenges for clinical prediction of infection. We describe the epidemiology and clinical disease of candidemia in children admitted to a tertiary pediatric hospital. Methods: Retrospective audit of children ≤18 years of age with candidemia at a tertiary pediatric hospital over a 16-year period. Results: There were 139 episodes of candidemia in 124 children. A central venous catheter was present in 94% of episodes, prior antibiotic exposure in 86% and parenteral nutrition in 43%. During the study period, the proportion of candidemia due to non-albicans Candida spp. increased primarily due to a rise in C. krusei. Colonization with Candida spp. in the 30 days before developing candidemia was identified in 40% of episodes and the species was concordant in 60%. Infection at other sites was rare, including pulmonary dissemination (9/38, 24%), renal fungal disease (9/114, 8%), fungal endophthalmitis (8/102, 8%) and hepatosplenic nodules (5/92, 5%). Overall, 8/127 (6%) isolates were fluconazole-resistant (7 C. krusei and 1 C. glabrata) and 7/127 (6%) had intermediate susceptibility to fluconazole. The overall 30-day mortality was 12% and significant risk factors for mortality on multivariate analysis were male sex, liver disease and mucositis. Conclusions: Our study outlines low rates of disseminated candidiasis and low mortality associated with candidemia at our institution. Additionally, it suggests that prior colonization may be an important risk factor, however, this should be validated in large prospective controlled studies.

Evaluation of candidemia in children at a university hospital: A retrospective cohort

“…This study evaluated 342 candidemia episodes in 311 paediatric patients during a 13‐year period in a large university hospital in the Aegean region of Turkey. We found a higher rate of NAC (67.5%) candidemia than CA (32.5%) candidemia, similar to previous reports 8,22–27 . Based on the univariate analysis, a history of CoNS culture positivity in the last month, TPN and antifungal prophylaxis were significantly more common in the NAC group.…”

“…1,26 NAC, particularly C. parapsilosis, shows an increasing prevalence in children with fungal bloodstream infections. [24][25][26][27] This rising trend of C. parapsilosis has been associated with many factors, such as biofilm formation resulting in an affinity for intravascular devices and prosthetic materials, colonisation of the gastrointestinal system and hand contamination by healthcare workers. use have been identified as risk factors for NAC candidemia in adults.…”

“…Silvester et al 25 reported that 42% of their patients developed breakthrough candidemia, which was more commonly caused by NAC spp. (76%) during 16 years period.…”

“…The mortality rate of paediatric candidemia ranges from 3.9% to 43% in paediatric patients beyond the neonatal period. 8,11,25,27,33 A recent study that evaluated candidemia episodes in children admitted to the PICU found a higher mortality rate for NAC candidemia than for CA candidemia, but without statistical significance. 22 In another paediatric study, the attributable mortality rates due to CA and NAC did not differ on the 7th and 30th days of candidemia.…”

Fungaemia due to rare yeasts in paediatric intensive care units: A prospective study

“…6 However, a noticeable rise in candidaemia cases due to non-albicans Candida species particularly C. krusei and C. lusitaniae was recorded in paediatric patients of Australia and United States, respectively. 7,8 In contrast to the above findings, a recent multicentric study from India reported isolation of many rare yeasts from ICU-acquired candidaemia cases in paediatric ICUs at our centre. 9 The emergence of rare yeasts may be attributed to thermal adaptation, local climatic factors, aggressive medical intervention in critically ill patients, improvement in the identification of causative agent, and antifungal pressure.…”