Invasive candidiasis in pediatric intensive care units

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Mycology

Background:

• Candidemia and disseminated candidiasis are significant causes of mortality in hospitalized patients, particularly in intensive care units (ICUs).
• The incidence of invasive candidiasis is increasing globally, linked to the widespread use of broad-spectrum antibiotics and invasive procedures.
• A shift towards non-albicans Candida species is observed, correlating with higher mortality and antifungal resistance.

Purpose of the Study:

• To review the current landscape of candidemia and disseminated candidiasis in ICUs.
• To highlight the changing trends in causative species and associated antifungal resistance.
• To discuss clinical manifestations, risk factors, and current treatment strategies, including the role of Amphotericin B.

Main Methods:

• Literature review of candidemia and disseminated candidiasis in ICU settings.
• Analysis of epidemiological trends, focusing on species distribution and antifungal resistance patterns.
• Synthesis of clinical presentation, risk factors, and therapeutic recommendations.

Main Results:

• Invasive candidiasis incidence is rising, with a trend towards non-albicans species.
• Increased antifungal resistance is a growing concern, impacting treatment efficacy.
• Risk factors in ICUs include broad-spectrum antibiotics, parenteral nutrition, and central venous catheters.

Conclusions:

• Early recognition and source control are crucial for managing candidiasis.
• Amphotericin B is the preferred initial treatment for hemodynamically unstable, critically ill children due to azole resistance.
• Further research is needed on newer antifungal agents and prophylactic strategies in ICU patients.