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An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Invasive candidiasis in pediatric intensive care patients: epidemiology, risk factors, management, and outcome
Joanna Filioti1, Kleomenis Spiroglou1, Emmanuel Roilides2
13rd Department of Pediatrics, Aristotle University, Hippokration Hospital, Konstantinoupoleos 49, 54642, Thessaloniki, Greece.
Insights
Pediatric invasive Candida infections (ICI) are rising, especially in vulnerable infants. Management focuses on prompt line removal, antifungal therapy, and understanding evolving species like non-albicans Candida (NAC).
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Candidemia incidence increases in pediatric patients, mirroring adults but at a greater rate.
- Critically ill children, especially neonates, face heightened vulnerability to invasive Candida infections (ICI).
- Invasive procedures and underlying conditions contribute to increased ICI risk in pediatric populations.
Purpose of the Study:
- To analyze the epidemiology and risk factors of invasive Candida infections in pediatric patients.
- To highlight the changing landscape of Candida species causing ICI, including the rise of non-albicans species.
- To review current and novel treatment strategies for ICI in critically ill children.
Main Methods:
- Retrospective analysis of pediatric candidemia cases.
- Review of risk factors associated with ICI, including medical devices and treatments.
- Evaluation of antifungal agents and treatment outcomes.
Main Results:
- Central venous catheters, arterial lines, parenteral nutrition, mechanical ventilation, and prolonged antimicrobial use are significant risk factors for ICI.
- Candida albicans remains prevalent, but non-albicans (NAC) species, particularly C. parapsilosis and C. tropicalis, now constitute nearly half of ICI cases.
- Increased prophylactic antifungal use in immunocompromised patients is linked to shifts in Candida species distribution, impacting mortality and treatment choices.
Conclusions:
- Prompt removal of invasive lines and timely antifungal treatment are crucial for managing pediatric ICI.
- Conventional amphotericin B, lipid formulations, and fluconazole are common treatments, with newer agents like triazoles and echinocandins showing promise.
- Improved understanding of risk factors, prevention, and novel therapies offers hope for better outcomes in critically ill children with ICI.
Background:
The incidence of candidemia in pediatric patients follows the same pattern of increase as in adults, but the rate of increase is greater. Pediatric patients in critical condition, particularly young infants, are especially vulnerable to invasive Candida infections (ICI), partly because of their age and severe underlying disease and partly because of the invasive procedures used.
Discussion:
Central venous catheters and arterial lines, parenteral nutrition, mechanical ventilation and extended use of antimicrobials enhance the risk of ICI. C. albicans continues to be the most prevalent isolate. However, an increasing role of non-C. albicans (NAC) spp., some of which are intrinsically or potentially resistant to antifungal agents, has been observed. NAC spp., particularly C. parapsilosis and C. tropicalis, account for almost half of ICI. The increased use of antifungals in immunocompromised patients, mainly prophylactically, is considered the strongest contributory factor to the changes in species distribution, which have subsequently affected the mortality and choice of empirical treatment.
Conclusions:
Prompt removal of lines and initiation of antifungal treatment are the milestones of management. Conventional amphotericin B remains a commonly used antifungal agent, but its lipid formulations and fluconazole are also used frequently. Novel antifungal agents such as second-generation triazoles and echinocandins exhibit potential as alternative agents in critically ill children with ICI. Although response rates are still far from satisfactory, improved understanding of risk factors, preventive strategies and new treatment options promise a better future outcome.
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