Changing Epidemiology of Invasive Candidiasis in Children during a 10-Year Period

Abstract

Candida species are a common cause of invasive infection in neonates and children. The aim of our study was to evaluate the epidemiology and microbiology of invasive candidiasis (IC) in the largest tertiary Greek pediatric hospital during a 10-year period. A retrospective cohort study was performed from January 2008 to December 2017. Identification of species and antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) methodology. During the study period, 178 cases of IC were recorded. The tissue distribution included blood (87.1%), cerebrospinal (7.9%), peritoneal (3.9%) and pleural fluids (1.1%). Candida albicans and Candida parapsilosis (sensu lato) were the most frequently isolated species (47.8% and 28.7% respectively). From period 2008–2012 to period 2013–2017, a significant decrease in IC rates was detected (0.21 cases/1000 hospitalization days VS 0.11 cases/1000 hospitalization days, P = 0.040), while median minimum inhibitory concentrations (MICs) of amphotericin B were significantly increased for both C. albicans and C. parapsilosis (sl) (P = 0.037 and P = 0.004 respectively). The decrease in IC rates may reflect the increased awareness as well as the effective infection control initiatives and antifungal interventions. However, the significant increase in the MICs for amphotericin B and echinocandins such as caspofungin, raises concerns about their common use as first-line treatment. Epidemiologic monitoring is, therefore, critically important in order to evaluate and optimize therapeutic protocols for IC in pediatric populations.

Epidemiological Trends of Fungemia in Greece with a Focus on Candidemia during the Recent Financial Crisis: a 10-Year Survey in a Tertiary Care Academic Hospital and Review of Literature

“…In particular, it occurred in 3/34 (9%) of C. glabrata SC strains (1/3 was panechinocandin resistant), whereas 1/136 (1%) C. albicans isolates was found to have intermediate susceptibility only to caspofungin. In our literature review, the majority of the recovered Candida isolates were susceptible to echinocandins (94 to 100%) but less so to caspofungin (75 to 100%) (15,17,18,27,(30)(31)(32), contrary to our study, where Ն99% susceptibility to all three echinocandins was found. Since the mono-echinocandin resistance phenotype is rare, the lower caspofungin susceptibility rates found in previous studies where Etest was used may be due to technical issues in MIC reading with this test (52) and the criteria used to interpret the results (53).…”

“…Fifteen articles reported data from single hospitals and four from multicenter or nationwide studies, whereas in one study, the origin was not reported. The majority of them (12/20; 60%) were performed in intensive care units (ICUs) (3/20 in neonatal/pediatric ICUs [14][15][16] and 9/20 in adult ICUs [17][18][19][20][21][22][23][24][25]), 1/20 in internal medicine wards (IMWs) (26), 2/20 in pediatric patients (27,28), 2/20 in patients with hematological malignancies (29,30), and only 3/20 in the general patient population (all hospital units) (31)(32)(33). Over the years, the most commonly isolated Candida species was C. albicans, with a frequency ranging from 12.5% to 89.5%.…”

“…1). Antifungal susceptibility data, mainly (75%) using the Etest, were available in 12/20 studies (15-19, 21, 27, 29-33), with 8/12 not testing echinocandins or testing only caspofungin (15,16,18,19,27,30,32,33) and 2/12 not mentioning resistance rates per drug (21,29). The reported susceptibility rates were 98.5 to 100% for amphotericin, 93 to 100% for flucytosine, 94 to 98% for anidulafungin, 98 to 100% for micafungin, 75 to 100% for caspofungin, 95 to 100% for voriconazole, 75 to 98.5% for fluconazole, 25 to 94% for itraconazole, 70.6 to 92.5% for posaconazole, and 80.4 to 90% for ketoconazole.…”

Invasive Candida Infections in a Pediatric Intensive Care Unit in Turkey: Evaluation of an 11-Year Period

“…Noni et al in their retrospective study including 178 pediatric cases from three neonatal intensive care units, one PICU, two hematology-oncology units, and one bone marrow transplantation unit in Greece reported that the most isolated species were C. albicans and C. parapsilosis. 22 In a study performed on 102 children with nosocomial candidemia in our country between 1997 and 2005, non-albicans Candida species were the most common species. 23 In another single-center study performed on children with malignancy and nosocomial candidemia in our country between 2007 and 2013, non-albicans candidemia was determined in 81.4% of 135 candidemia episodes.…”

Postbiotics against Pathogens Commonly Involved in Pediatric Infectious Diseases

“…In the United States, invasive candidiasis in the pediatric population mainly occurs in neonates and infants less than one year of age and can often lead to high mortality rates [ 110 ]. Prematurity and admission to the intensive care unit are considered the main predisposing factors for candidiasis [ 111 ]. Prevention against fungal infection in preterm infants can be achieved through antifungal medication, but there are strong concerns over potential adverse effects and the possible emergence of resistant strains [ 112 ].…”