Related Experiment Video
Updated: Aug 23, 2026
An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Risk factors for disseminated candidiasis in children with candidemia
Theoklis E Zaoutis1, H Mollie Greves, Ebbing Lautenbach
1Division of Infectious Diseases, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. zaoutis@email.chop.edu
Insights
Prolonged candidemia with a central venous catheter and immunosuppression are key risk factors for disseminated fungal infections in children. Early identification and intervention are crucial for better outcomes in pediatric candidemia cases.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Clinical Epidemiology
Background:
- Candidemia, a serious bloodstream infection caused by Candida species, poses a significant threat to hospitalized children.
- Disseminated candidiasis, where the infection spreads to internal organs, requires prompt diagnosis and management.
- Identifying risk factors for dissemination is crucial for targeted prevention and treatment strategies.
Purpose of the Study:
- To identify independent risk factors associated with disseminated candidiasis in pediatric patients diagnosed with candidemia.
- To analyze the epidemiological characteristics of candidemia in a tertiary care children's hospital.
Main Methods:
- A nested case-control study was conducted within a cohort of hospitalized children with candidemia (1998-2001).
- Cases were defined by evidence of disseminated candidiasis, while controls had no such evidence.
- Statistical analysis identified independent risk factors for dissemination.
Main Results:
- Among 168 children with candidemia, 26 (17%) developed disseminated candidiasis.
- Independent risk factors for dissemination included persistently positive blood cultures for Candida (>3 days) with a central venous catheter (OR, 3.0) and immunosuppression (OR, 2.9).
- Candida albicans was the most common species (41%), but non-albicans species were also prevalent, with Candida parapsilosis (24%) being the second most common.
Conclusions:
- Prolonged candidemia with a central venous catheter and immunosuppression are significant independent risk factors for disseminated candidiasis in children.
- The study highlights a heterogeneous pediatric population at risk and a notable proportion of non-albicans Candida infections.
- Further research is needed to optimize diagnostic evaluations and develop preventive interventions for disseminated candidiasis in children.
Objective:
To determine the risk factors for disseminated infection in hospitalized children with candidemia.
Methods:
We performed a nested case-control study within a cohort of hospitalized children with candidemia. The cohort was defined by all patients with positive blood cultures for Candida species in a large, urban, academic, tertiary care children's hospital from 1998 to 2001. Cases were patients with clinical, microbiologic or radiographic evidence of disseminated candidiasis. Controls were patients with no evidence of disseminated candidiasis.
Results:
Among 168 total children with candidemia, the median age was 3.5 years (interquartile range, 0.6-14.3). There were 189 episodes of candidemia. Candida species included:Candida albicans (41%), Candida parapsilosis (24%), Candida glabrata (13%) and Candida tropicalis (9%). The most common underlying diagnoses were oncologic (24%), gastrointestinal (15%) and cardiac (10%) diseases. Eighty-nine patients (53%) were admitted to an intensive care unit, 46 (27%) to a general pediatric or surgical ward and 33 (20%) to the oncology ward. Of the 168 patients with candidemia, 153 were included in the analysis of risk factors for disseminated candidiasis. Of 153 (17%) patients, 26 had evidence of organ dissemination. Organ involvement was most commonly identified in the lung (58%), followed by the liver (23%), kidney (16%), brain (12%), spleen (8%), eye (8%) and heart (8%). Eight of the 26 patients had evidence of dissemination to more than 1 organ. Independent risk factors for disseminated candidiasis were persistently positive blood cultures for Candida (>3 days) with a central venous catheter in place (odds ratio, 3.0; 95% confidence interval, 1.2, 7.8; P = 0.02) and immunosuppression (odds ratio, 2.9; 95% confidence interval, 1.2, 7.0; P = 0.02).
Conclusions:
Prolonged duration of candidemia with a central venous catheter in place and immunosuppression were independent risk factors for disseminated candidiasis in children with candidemia. Furthermore review of the epidemiology of candidemia at our institution revealed a heterogeneous population of children at risk for candidemia and a predominance of non-albicans species as the cause of these infections. Future studies are needed to determine the extent of evaluation needed for detecting dissemination among children with candidemia and to explore interventions for its prevention.
Related Concept Videos
01:20Candidiasis
01:27Cryptococcal Meningitis
01:28Fungal Phylum Microsporidia
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin create...
01:23Skin Diseases and Disorders
Gram-positive Staphylococcus spp. and Streptococcus spp. are responsible for many of the most common skin infections. However, many...
01:28Amebiasis