Not Just Little Adults: Candidemia Epidemiology, Molecular Characterization, and Antifungal Susceptibility in Neonatal and Pediatric Patients

Blyth, Christopher C; Chen, Wen; Slavin, Monica A; Serena, Carolina; Nguyen, Quoc; Marriott, Deborah; Ellis, David; Meyer, Wieland; Sorrell, Tania C.

doi:10.1542/peds.2008-2055

Cited by 168 publications

(190 citation statements)

References 37 publications

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“…The overall species distribution observed in our national survey contrasts with other studies where C. albicans is the first species isolated in children, followed by C. parapsilosis (2,3,23,26). However, in the study published by Neu et al, C. parapsilosis is the predominant species regardless of the patients' comorbidity or age group (10).…”

Section: Discussioncontrasting

confidence: 99%

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Epidemiology and Antifungal Susceptibility of Bloodstream Fungal Isolates in Pediatric Patients: a Spanish Multicenter Prospective Survey

et al. 2011

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Data on fungemia epidemiology and antifungal susceptibility of isolates from children are scarce, leading frequently to pediatric empirical treatment based on available adult data. The present study was designed to update the epidemiological, mycological, and in vitro susceptibility data on fungal isolates from children with fungemia in Spain. All fungemia episodes were identified prospectively by blood culture over 13 months at 30 hospitals. Tests of susceptibility to amphotericin B, flucytosine, fluconazole, itraconazole, posaconazole, voriconazole, anidulafungin, caspofungin, and micafungin were performed at participant institutions by a microdilution colorimetric method. New species-specific clinical breakpoints for fluconazole, voriconazole, and echinocandins were also applied. A total of 203 episodes of fungemia in 200 children were identified. A higher proportion of fungal isolates was from general wards than intensive care units (ICU). Candida parapsilosis (46.8%), Candida albicans (36.5%), Candida tropicalis (5.9%), Candida glabrata (3.9%), and Candida guilliermondii (2.5%) were the leading species. C. parapsilosis was the predominant species except in neonates. C. albicans was the most frequent in neonatal ICU settings (51.9%). Intravascular catheter (79.3%), surgery (35%), prematurity (30%), and neutropenia (11%) were the most frequent predisposing factors. Most Candida isolates (95.1%) were susceptible to all antifungals. When the new species-specific clinical breakpoints were applied, all C. parapsilosis isolates were susceptible to echinocandins except one, which was micafungin resistant. This is the largest published series of fungemia episodes in the pediatric setting. C. parapsilosis is the most prevalent species in Spain, followed by C. albicans and C. tropicalis. Resistance to azole and echinocandin agents is extremely rare among Candida species. The fluconazole resistance rate in Spain has decreased in the last 10 years.

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Section: Discussioncontrasting

confidence: 99%

“…This rate of mixed infection is similar to those reported in other series (2,3). Interestingly, in two of the four fungemia episodes concerning C. lusitaniae, this species was isolated in combination with another yeast.…”

Section: Discussionsupporting

confidence: 90%

Epidemiology and Antifungal Susceptibility of Bloodstream Fungal Isolates in Pediatric Patients: a Spanish Multicenter Prospective Survey

et al. 2011

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“…İnvaziv Candida enfeksiyonlarında en sık izole edilen türün Candida albicans ikinci sırada ise C.parapsilosis olduğu bilinmektedir [3][4][5][6][7][8][9] . Bizim çalışmamızda C.albicans (%55.1) en sık izole edilen Candida türü iken C.parapsilosis (%27.5) ikinci en sık izole edilen Candida türü idi.…”

Section: Discussionunclassified

Pediatrik Candida Enfeksiyonları: Tek Merkez Deneyimi

Çağan¹,

Soysal²,

Bakır³

2015

Cukurova Medical Journal

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Purpose: Candida is third place in the list of factors in healthcare-related bloodstream infections in the United States of America and Europe. Invasive fungal infections increase the hospital stay, costs and morbidity of critical and immunosuppressed patients. The aim of this study is to investigate the types, risk factors and clinical progress of Candida infections and to contribute to the insufficient literature on this topic. Material and Methods: The files of 29 pediatric patients with invasive Candida infection between January 2011 and January 2013 at Marmara University Faculty of Medicine were retrospectively investigated. Results: Twenty-nine patients were diagnosed with Candida infection. Of these patients 17 were male (59%) and 12 were female (41%). Eleven patients were less than a year old (38%), 9 were between 1-5 years (31%) and 9 were above the age of five (31%). The most important underlying disease malignancies were congenital heart disease and neurological diseases. Candida growth was determined in the blood cultures of 17 patients, the urine cultures of 10 patients and in the cerebrospinal fluid of one patient. While the most commonly used anti-fungal agent was fluconazole (51.7%), others used were caspofungin (41.3%) and amfoterisin B (13.7%). No isolated Candida strain showed resistance to anti-fungal agents. Treatment was clinically and microbiologically 96.5% successful. Conclusions: Fluconazole still appears to be an effective treatment choice we believe there is a necessity to review the Minimal Inhibitory Concentration (MIC) values for anti-fungal agents. Key words: Fluconazole, Antifungal, Candida, Child ÖZET Amaç: Candida enfeksiyonları Amerika Birleşik Devletleri ve Avrupa'da sağlık hizmeti ilişkili kan akım enfeksiyonları etkenleri arasında üçüncü sırada yer almaktadır. İnvaziv mantar enfeksiyonları kritik hastalarda ve immün yetmezlikli hastalarda hastanede kalış süresini, maliyetleri, mortalite ve morbiditeyi arttırmaktadır. Bu çalışmanın amacı Candida enfekyonlarının tiplerini, risk faktörlerini ve klinik gidişlerini incelemek ve bu konuda yeterli veri olmayan literatüre katkıda bulunmaktır. Materyal ve Metod: Ocak 2011-Ocak 2013 tarihleri arasında Marmara Üniversitesi Tıp Fakültesi'nde çocuk hastalarda görülen invaziv Candida enfeksiyonu tespit edilen 29 hastanın dosyaları retrospektif olarak incelendi. Bulgular: Candida enfeksiyonu geçiren 29 hasta tespit edildi. Bu hastaların 17'si (%59) erkek, 12'si (%41) kızdı. Onbir (%38) hasta bir yaş altı, 9 (%31) hasta 1-5 yaş arası, dokuz (%31) hasta beş yaş üzerindeydi. Altta yatan en önemli hastalık malignite, doğumsal kalp hastalığı ve nörolojik hastalıklar idi. On yedi hastanın kan kültüründe, on hastanın idrar kültüründe, bir hastanın beyin omurilik sıvısında Candida üremesi tespit edildi. En fazla kullanılan antifungal ajan flukonazol (%51.7) iken diğerleri kaspofungin (%41.3) amfoterisin B (%13.7) idi. İzole edilen hiçbir Candida türünde antifungal ajanlara karşı direnç tespit edilmedi. Tedavide klinik ve mikrobiyolojik %9...

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“…Accurate species identification among the C. parapsilosis complex is also becoming crucial in clinical management. 12,50 The rapid detection of C. parapsilosis is now clinically relevant because the revised recommendations for the treatment of candidiasis favor fluconazole in comparison with echinocandins as first-line therapy for infections due to this species. 22 This species was detected and easily identified by our twin PCR/RFLP method given that all C. parapsilosis strains in this study constantly exhibited the same IGSAF profile.…”

Section: Discussionmentioning

confidence: 99%

Molecular Identification of Closely Related Candida Species Using Two Ribosomal Intergenic Spacer Fingerprinting Methods

Cornet

Sendid

Fradin

et al. 2011

The Journal of Molecular Diagnostics

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Recent changes in the epidemiology of candidiasis highlighted an increase in non-Candida albicans species emphasizing the need for reliable identification methods. Molecular diagnostics in fungal infections may improve species characterization, particularly in cases of the closely related species in the Candida complexes. We developed two PCR/restriction fragment length polymorphism assays, targeting either a part of the intergenic spacer 2 or the entire intergenic spacer (IGS) of ribosomal DNA using a panel of 270 isolates. A part of the intergenic spacer was used for discrimination between C. albicans and C. dubliniensis and between species of the C. glabrata complex (C. glabrata/C. bracarensis/C. nivariensis). The whole IGS was applied to C. parapsilosis, C. metapsilosis, and C. orthopsilosis, and to separate C. famata (Debaryomyces hansenii) from C. guilliermondii (Pichia guilliermondii) and from the other species within this complex (ie, C. carpophila, C. fermentati and C. xestobii). Sharing similar biochemical patterns, Pichia norvegensis and C. inconspicua exhibited specific IGS profiles. Our study confirmed that isolates of C. guilliermondii were frequently misidentified as C. famata. As much as 67% of the clinical isolates phenotypically determined as C. famata were recognized mostly as true P. guilliermondii. Conversely, 44% of the isolates initially identified as C. guilliermondii were corrected by the IGS fingerprints as C. parapsilosis, C. fermentati, or C. zeylanoides. Current changes in the epidemiology of invasive mycoses highlighted a shift in the Candida species involved with a reduced proportion of C. albicans and an increase in non-C. albicans species. [1][2][3][4] In the most recent series, including the large cohort of 2019 patients with candidemia enrolled from 2004 through 2008, C. albicans accounts for less than one half of the isolates.3,5-12 Although C. albicans antifungal susceptibility remains the rule, and reports on resistant isolates are very scarce, other species such as C. krusei, C. glabrata, C. bracarensis, C. nivariensis, C. parapsilosis, and C. guilliermondii are either innately resistant or show decreased susceptibility patterns to azoles, amphotericin B, or echinocandins.13-21 Thus, the therapeutic impact of this shift might be critical and should be considered in patient management. Consistent with this trend, the recent revision of the consensus guidelines actually recommends an adjustment of the treatment according to the isolated Candida species. 22 In yeasts, there is no transfer of resistance between cells and acquisition of resistance, which is mainly observed in restricted clinical settings such as allogeneic blood marrow transplant or AIDS patients under sustained prolonged azole treatment. 5,14,23 Therefore, species identification remains basically predictive of drug susceptibility. Current methods for yeast identification in clinical practice are based on phenotypic features and carbohydrate assimilation tests that require 2 to 5 days or even longer in the case ...

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Not Just Little Adults: Candidemia Epidemiology, Molecular Characterization, and Antifungal Susceptibility in Neonatal and Pediatric Patients

Abstract: This study identifies significant differences in candidemia in neonates, children, and adults. Neonatologists and pediatricians must consider age-specific differences when interpreting adult studies and developing treatment and prevention guidelines.

Cited by 168 publications

References 37 publications

Epidemiology and Antifungal Susceptibility of Bloodstream Fungal Isolates in Pediatric Patients: a Spanish Multicenter Prospective Survey

Epidemiology and Antifungal Susceptibility of Bloodstream Fungal Isolates in Pediatric Patients: a Spanish Multicenter Prospective Survey

Pediatrik Candida Enfeksiyonları: Tek Merkez Deneyimi

Molecular Identification of Closely Related Candida Species Using Two Ribosomal Intergenic Spacer Fingerprinting Methods

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