A Prospective Observational Study of Candidemia: Epidemiology, Therapy, and Influences on Mortality in Hospitalized Adult and Pediatric Patients

Abstract

We conducted a prospective, multicenter observational study of adults (n=1447) and children (n=144) with candidemia at tertiary care centers in the United States in parallel with a candidemia treatment trial that included nonneutropenic adults. Candida albicans was the most common bloodstream isolate recovered from adults and children (45% vs. 49%) and was associated with high mortality (47% among adults vs. 29% among children). Three-month survival was better among children than among adults (76% vs. 54%; P<.001). Most children received amphotericin B as initial therapy, whereas most adults received fluconazole. In adults, Candida parapsilosis fungemia was associated with lower mortality than was non-parapsilosis candidemia (24% vs. 46%; P<.001). Mortality was similar among subjects with Candida glabrata or non-glabrata candidemia; mortality was also similar among subjects with C. glabrata candidemia who received fluconazole rather than other antifungal therapy. Subjects in the observational cohort had higher Acute Physiology and Chronic Health Evaluation II scores than did participants in the clinical trial (18.6 vs. 16.1), which suggests that the former subjects are more often excluded from therapeutic trials.

Phase 2, Randomized, Dose-Ranging Study Evaluating the Safety and Efficacy of Anidulafungin in Invasive Candidiasis and Candidemia

“…Our study enrolled a repre- sentative sample of patients with candidemia. The distribution of baseline pathogens mirrored recent surveys of candidemia, with half of all isolates being non-albicans Candida species (13,16). Although patients in the two higher-dosage groups had higher APACHE II scores at baseline than those in the lowestdosage group, a higher success rate was observed in the higherdosage groups.…”

Invasive fungal infections in the pediatric population

“…Importantly, in children aged younger than 1 year, the incidence of Candida parapsilosis is considerably higher than that of Candida glabrata, whereas in adolescents, the incidence of C. glabrata may exceed the incidence of C. parapsilosis [9]. Overall, the rate of mortality due to invasive candidiasis is lower in children compared with adults [10].…”

(1‐aryloxy‐2‐hydroxypropyl)‐phenylpiperazine derivatives suppress Candida albicans virulence by interfering with morphological transition

“…It can also induce life‐threatening systemic infections known as candidemia in immunocompromised patients (Miller et al ., 2001; Pappas et al ., 2003). C. albicans has a distinguishing feature, the yeast‐to‐hyphae dimorphism, which is the most important virulence factor that enables C. albicans to infect humans (Madhani and Fink, 1998; Brown and Gow, 1999; Staib et al ., 2000).…”