Candidemia in a Pediatric Population

Abstract

Candidemia results in a mortality of > 50% among adults, but data on children with candidemia are limited. We reviewed 70 episodes of pediatric candidemia that occurred between January 1988 and October 1992. Of these episodes, 53% were caused by Candida albicans, 24% were caused by Candida parapsilosis, 16% were caused by Candida tropicalis, and 3% were caused by Candida krusei. Twenty-five percent of the patients were premature infants. Other underlying conditions included malignancy (15%); cardiac disease (14%); and short-gut syndrome (14%). A central venous catheter was in place during 61 (87%) of 70 episodes. Candiduria preceded candidemia in only 4 (8%) of 52 patients. The overall mortality rate was 19%; 36% of those with intravenous catheters that were not removed within 3 days died, whereas none of the patients from whom catheters were removed within 3 days died (P < .0001). Only two survivors had complications. Therapy with amphotericin B (with or without flucytosine) was administered to 74% of these patients. Seventeen patients were not treated medically; all were immunocompetent and survived. Of these patients, 15 were > 2 months of age; 14 had candidemia for < or = 2 days; and 15 had an intravenous catheter removed within 2 days of the onset of candidemia. No patient stopped receiving amphotericin B because of side effects. The results of this study suggest the following: that mortality associated with candidemia is lower among children than among adults; that failure to remove the indwelling intravenous catheter usually results in a poor outcome; that candiduria rarely precedes candidemia in children; and that amphotericin B is well tolerated by children.

Characteristics and risk factors of candidemia in pediatric intensive care unit of a tertiary care children's hospital in Egypt

“…The association of C. parapsilosis BSIs and CVC-related candidemia found in this study is consistent with previous reports of the association between C. parapsilosis and CVC [21,23,24] .…”

Detection of Fungemia by Polymerase Chain Reaction in Critically Ill Neonates and Children

“…1 Increased survival of very low-birth-weight infants and other immunocompromised patients, as well as increased use of indwelling intravascular catheters, broad-spectrum antibiotics, steroids, and parenteral alimentation have contributed to an increase in Candida sepsis over the last decade. 2,3 A recent survey of very low birth-weight (less than 1500 g) infants revealed that fungal species, predominantly Candida albicans, were responsible for 9% of all cases of late-onset sepsis with 28% mortality. 4 Another study documented a 10-fold increase in the incidence of invasive candidiasis among hospitalized neonates in the last 15 years.…”

“…Mortality from disseminated fungal infection is approximately 20 to 30% in NICU and PICU patients, [6][7][8] but may increase to greater than 50% if treatment is delayed. 2,9,10 Early detection of fungal sepsis and institution of appropriate therapy has been shown to improve patient outcome. 2,10 In one study, patients with candidemia of more than 2 days' duration prior to initiation of antifungal therapy had a two-fold higher mortality than those who were treated more promptly.…”

“…2,9,10 Early detection of fungal sepsis and institution of appropriate therapy has been shown to improve patient outcome. 2,10 In one study, patients with candidemia of more than 2 days' duration prior to initiation of antifungal therapy had a two-fold higher mortality than those who were treated more promptly. 11 Early removal of central venous catheters in neonates and children with candidemia is also associated with significantly decreased mortality and morbidity.…”

Comparison of Nosocomial Candidemia of Pediatric and Adult Cases in 2-Years Period at a Turkish University Hospital

“…This finding differed from those of previous studies. Numerous studies [10,11,15,16] have found lower mortality rates in pediatric patients than in adults. In a large, prospective study of candidemia, it was shown that the mortality rate due to candidemia caused by C. parapsilosis was usually lower than that of candidemia caused by other Candida species.…”