Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia

Abstract

We aimed to determine the clinical and microbiological characteristics of Candida bloodstream infections in children and the impact of therapeutic strategies on outcomes. All pediatric patients with candidemia from a medical center in Taiwan over a 13-year period (2003–2015) were included and a total of 262 patients with 319 episodes of candidemia were analyzed. Overall susceptibility to fluconazole was 86.1%. Cumulative mortality at 7 and 30 days after the first episode of candidemia was 13.4% and 25.2%, respectively. The overall in-hospital mortality rate was 35.1%. The treatment outcomes did not change over the study period. Multivariate analysis showed that delayed catheter removal (odds ratio [OR], 5.52; 95% confidence interval [CI]: 2.97–10.25), septic shock (OR, 5.49; 95% CI: 2.85–10.57), and breakthrough candidemia (OR, 3.66; 95% CI: 1.43–9.35) were independently associated with clinical treatment failure. In children with candidemia, underlying renal insufficiency and hematological/oncological malignancy, delayed catheter removal, and septic shock at onset were independently associated final in-hospital mortality. Analyzing the subgroup of non-neonatal children did not change the findings. We concluded overall mortality of pediatric candidemia remains high during the past decade. Prompt early catheter removal and aggressive treatment strategy in patients with septic shock would be critical to improve outcomes.

Candidemia in children: Epidemiology, prevention and management

“…In critically ill children with underlying haematologic malignancies, the incidence rate of candidemia is in the range of 5 per 1000 Paediatric Intensive Care Unit (PICU) admissions and the 30‐day mortality is in the range of 20% . A recent analysis of 319 episodes of candidemia in 262 children treated in a single medical centre in Taiwan over a 13‐year period (2003‐2015) showed a cumulative mortality of 13.4% at 7 and 25.2% at 30 days after the first episode of candidemia, with no change over the study period . An urgent need to combat candidemia has been recognised in recent years …”

“…5 A recent analysis of 319 episodes of candidemia in 262 children treated in a single medical centre in Taiwan over a 13-year period (2003-2015) showed a cumulative mortality of 13.4% at 7 and 25.2% at 30 days after the first episode of candidemia, with no change over the study period. 6 An urgent need to combat candidemia has been recognised in recent years. 7,8 Historically, the highest rates of candidemia have been recorded in neonates and infants <1 year of age.…”

Antifungal Resistance of Candida Species in Bacolod City, Philippines

“…Fungal infections, especially by opportunistic species like Candida have been considered as an increasing problem among older adults because older patients may have received transplants, underwent aggressive treatment for malignancies, taking immunosuppressive drugs for dermatologic or rheumatic diseases and other age-related physiological changes [22,37]. Additionally, this age group is at risk for fungal infection when they underwent frequent and prolonged hospital treatment.…”

“…Additionally, this age group is at risk for fungal infection when they underwent frequent and prolonged hospital treatment. Moreover, renal failure, total parenteral nutrition, central intravenous catheters, broad-spectrum antibiotic treatment, and prior surgical procedures enhance the risk of Candida infection [37]. Candidemia has become a marker for a poor outcome in older adults with multiple underlying and lengthy ICU stay [28].…”

“…The preferred agent for the treatment of yeast infections has always been azoles, specifically fluconazole, since it is safer than Amphotericin B [37,38]. Its use, however, may be limited, especially fluconazole because of the increasing prevalence of Candida species with acquired or intrinsic resistance [22].…”