Invasive candidiasis in pediatric intensive care units

Abstract

Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C. albicans towards non albicans species, with an associated increase in mortality and antifungal resistance. In the ICU a predisposed host in one who is on broad spectrum antibiotics, parenteral nutrition, and central venous catheters. There are no pathognomonic signs or symptoms. The clinical clues are: unexplained fever or signs of severe sepsis or septic shock while on antibiotics, multiple, non-tender, nodular erythematous cutaneous lesions. The spectrum of infection with candida species range from superficial candidiasis of the skin and mucosa to more serious life threatening infections. Treatment of candidiasis involves removal of the most likely source of infection and drug therapy to speed up the clearance of infection. Amphotericin B remains the initial drug of first choice in hemodynamically unstable critically ill children in the wake of increasing resistance to azoles. Evaluation of newer antifungal agents and precise role of prophylactic therapy in ICU patients is needed.

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

“…NAC species, particularly C. parapsilosis and C. tropicalis, account for almost half of invasive Candida infections in pediatric patients [4,5]. Nonalbicans Candida became more frequent causative agents for invasive fungal infections in the ICU with high transmission of C. parapsilosis [6][7][8].…”

Frequency of Candida Species Isolated from Patients in Children’s Medical Center, Tehran, Iran

“…Colonization with Candida species is a risk factor for invasive candidiasis, as it may precede serious infections in critically ill patients (8). It has been shown that patients with severe Candida infections had a previous colonization with Candida (4,8,9). Since the clinical manifestations of invasive candidiasis is un-specific and diagnosis of infection is lengthy and insensitive, monitoring of yeast colonization might be useful for early prophylaxis of at risk predisposed patients.…”

“…Frequent use of antibiotics, oral and inhaled steroids predispose cystic fibrosis (CF) patients to oral colonization by Candida species as evidenced in a study in which C. albicans was isolated from the respiratory tract in 93% of CF patients (7,29). Singhi et al showed that colonization by Candida species occurred in 45 (69%) of patients admitted to PICU, with oropharyngeal (52%) and rectal (43%) colonization predominating; the colonizing species were C. tropicalis (34.2%), C. parapsilosis (28.8%), and C. albicans (14.4%) (9). Endogenous flora in the GI tract has been known to be an important local defense mechanism that prevents fungal proliferation (3).…”

“…Endogenous Candida within the gastrointestinal tract establish colonization which is recognized as an independent risk factor for invasive mycosis and an increased morbidity and mortality in ICU patients (1,3). ICU patients are frequently colonized with different Candida species, and it has been reported that colonization with Candida species occurs in approximately 70% of pediatric patients in the PICU; in one study about 90% of the patients who developed candidemia were colonized, 75% with the same Candida species (9). Presence of central venous catheter was also an independent risk factor for colonization (3).…”

“…However, in a study it was found that Candida respiratory tract colonization is associated with increased hospital mortality and prolonged hospitalization (7). The presence of Candida in endotracheal secretions needs to be interpreted in a clinical context (7), as Candida species are frequent asymptomatic colonizers of the upper respiratory tract, especially in hospitalized patients (9). In a primary Candida pneumonia, concomitant Candida esophagitis and colonization of the upper respiratory tract is frequently seen (7).…”