Pediatric Candidemia Epidemiology and Morbidities

Abstract

Introduction Candidemia is the most frequent pediatric fungal infection, but incompletely elucidated in population-based settings. We performed a nationwide cohort study including all pediatric patients with candidemia in Denmark from 2004-2014 to determine age, incidence, species distribution, underlying diseases, patient management and outcomes. Methods All candidemia episodes were identified through the active nationwide fungemia surveillance program. Susceptibility testing followed the EUCAST E.Def 7 reference method. Chi-squared test, Fisher's exact test and Venn diagrams were used for statistical analyses. Results 153 pediatric patients (≤15 years) with 158 candidemia episodes were identified. The overall annual incidence rate was 1.3/100,000 population, higher for neonates (5.7/100,000 live births) and low birth weight (LBW) neonates (103.8/100.000 live births). From 2004-9 to 2010-2014, the proportion of C. albicans decreased from 74.4% to 64.7%, whereas fluconazole resistance increased from 7.8% to 17.7%. Virtually all patients had at least one underlying disease (98.6%) and multimorbidity was common (43.5%, ≥2 underlying diseases). Underlying diseases differed by age with heart malformations and gastrointestinal disease prevalent in children younger than 3 years. The overall 30-days mortality was 10.2% and highest for neonates (17.1%). Mortality increased from 2004-to 2010-14, driven by an increase among older children. Discussion This first nationwide epidemiologic study of pediatric candidemia confirmed a high incidence among neonates and a substantial burden of comorbidities. Moreover, an increasing proportion of

Characteristics, outcome and risk factors for mortality of paediatric patients with ICU‐acquired candidemia in India: A multicentre prospective study

“…C albicans (median 52.5%) and C parapsilosis (median 30.0%) tend to dominate in western children, with C tropicalis (median 4.4%), C glabrata (median 4.3%), C krusei (median 3.6%) and C lusitaniae (median 3.2%) afflicting smaller proportions of children, especially those with malignancies, transplants and immunosuppression. 3,[16][17][18][19][20][21][22][24][25][26][27][28] In contrast, children in this study were most frequently infected with C tropicalis (24.7%), followed by C albicans (20.7%)…”

“…Candidemic children in this study, when compared to the west, contracted candidemia sooner after being admitted to the ICU (6.0 vs median 13.0 days). 3,16,17 Children in this study seldom experienced underlying malignancies (1.4% vs median 22.7%), neutropenia (2.0% vs median 11.7%), organ transplants (0.2% vs median 3.2%), chemotherapy (0.8% vs median 28.7%), immunosuppressive therapy (1.2% vs median 35.0%), parenteral nutrition (11.0% vs median 55.1%) or ventricular shunts (0.2% vs median 9.4%). 3,[16][17][18][19][20][21] They were exposed less frequently to precandidemia antifungals (15.5% vs median 24.7%), but were almost universally exposed to antibiotics (94.1% vs median 76.5%).…”

“…3,16,17 Children in this study seldom experienced underlying malignancies (1.4% vs median 22.7%), neutropenia (2.0% vs median 11.7%), organ transplants (0.2% vs median 3.2%), chemotherapy (0.8% vs median 28.7%), immunosuppressive therapy (1.2% vs median 35.0%), parenteral nutrition (11.0% vs median 55.1%) or ventricular shunts (0.2% vs median 9.4%). 3,[16][17][18][19][20][21] They were exposed less frequently to precandidemia antifungals (15.5% vs median 24.7%), but were almost universally exposed to antibiotics (94.1% vs median 76.5%). 3,[16][17][18][19][20][21] Although the use of CVC was lower (37.4% vs median 87.3%), yet overall postcandidemia CVC removal substantially lagged behind (44.8% vs 81.8%), 3,[16][17][18][19][21][22][23] as did institution of definitive antifungal therapy (66.5% vs median 88.2%) [16][17][18] and was accompanied by a higher 30-day mortality rate (28.4% vs median 13.7%) [16][17][18][19]21,22,24,25 as compared to the west.…”

“…Map of India depicting the 23 tertiary care centres and the number of ICU-acquired paediatric candidemia cases (in parentheses) contributed by them. PGIMER, Chandigarh, was the coordinating reference centre 07Safdarjang Hospital, Delhi (16) SJMC, Bangalore (20) SRMC, Chennai (22) UCMS, Delhi 14S , terling Hospital Ahmedabad 02and exposure to corticosteroids were considered potential predisposing factors, if they occurred ≤30 days before contracting candidemia in the ICU. Concomitant bacterial infections were defined as those occurring >48 hours after ICU admission or <48 hours after discharge, and confirmed by culture isolation.…”

Candidemia in Children with Malignancies: Report from the Infection Working Group of the Hellenic Society of Pediatric Hematology-Oncology

“…Although, it is widely accepted that the intestinal tract is the main source of candidemia, the importance of the colonization of the skin by C. parapsilosis has recently become apparent [7,8]. Major risk factors associated with candidemia are age < 1 year or >65 years, surgery, presence of a central venous catheter, total parenteral nutrition, previous antibiotic exposure, azotaemia, graft-versus-host disease and neutropenia after induction chemotherapy in acute leukemia patients [9][10][11][12]. Echinocandins and liposomal amphotericin B (L-AmB) are the first-line antifungal agents in the treatment of candidemia both for immunocompetent and immunocompromised patients and at the same time central venous catheter (CVC) removal is strongly recommended according to international consensus guidelines [13][14][15][16].…”