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Published on: July 1, 2020
Incidence and predictors of invasive candidiasis associated with candidaemia in children
Ara Festekjian1, Michael Neely
1Childrens Hospital Los Angeles, Los Angeles, CA, USA.
Insights
Premature infants and immunocompromised children face higher risks of invasive candidiasis during candidaemia. Extensive imaging and ophthalmological exams were low-yield in immunocompetent children.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Clinical Epidemiology
Background:
- Risk factors for invasive candidiasis in pediatric candidaemia are not well-defined.
- Candidaemia in children requires understanding of associated invasive fungal infections.
- Early identification of risk factors can guide diagnostic and therapeutic strategies.
Purpose of the Study:
- To identify risk factors associated with invasive candidiasis in children diagnosed with candidaemia.
- To evaluate the diagnostic yield of various investigations for invasive candidiasis.
- To determine the incidence of invasive candidiasis in pediatric candidaemia cases.
Main Methods:
- Retrospective cohort study of pediatric candidaemia cases from 2000-2006.
- Inclusion of 180 patients with available clinical records from 194 episodes.
- Diagnosis of invasive candidiasis based on EORTC/MSG criteria and medical record review.
Main Results:
- Invasive candidiasis was identified in 8% (15/180) of patients.
- Significant risk factors included prematurity (<32 weeks), immunocompromising disorders, and prolonged candidaemia (≥2 days).
- Extensive imaging and ophthalmological examinations showed low yield in immunocompetent children.
Conclusions:
- Prematurity and immunocompromised status are key risk factors for invasive candidiasis in pediatric candidaemia.
- Invasive candidiasis is uncommon but serious in this population.
- Targeted investigations are recommended, avoiding extensive, low-yield testing in specific pediatric groups.
Abstract:
Risk factors for invasive candidiasis in children with candidaemia are poorly defined. We performed a retrospective cohort study of all children with candidaemia at our tertiary children's hospital from 2000 to 2006. Invasive candidiasis was diagnosed by review of the medical record and standardised EORTC/MSG criteria. A variety of risk factors for invasive candidiasis were explored. Of 194 episodes of candidaemia in the microbiology laboratory database, 180 clinical records were available. Evaluation for invasive candidiasis consisted of 174 (97%) echocardiograms, 167 (93%) dilated ophthalmological examinations, 136 (76%) chest CT scans and 108 (60%) abdominal ultrasounds (complete, hepatosplenic or renal). Of the 180 patients, 15 (8%) were identified with invasive candidiasis (4 proven, 1 probable, 10 possible). Prematurity <32 weeks (P < 0.01), an underlying immunocompromising disorder (P < 0.01), and ≥2 days of candidaemia (P = 0.05) were significantly associated with invasive candidiasis. Invasive candidiasis, especially proven or probable, in the setting of candidaemia was not common in our hospital, but premature infants and immunocompromised children were at significantly higher risk. Based on our findings, extensive imaging and examination by an ophthalmologist were particularly low-yield for invasive candidiasis in immunocompetent children beyond infancy.
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