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Candida infections in non-neutropenic children after the neonatal period

Mustafa Hacimustafaoglu1, Solmaz Celebi

  • 1Uludag University Medical Faculty, Department of Pediatric and Pediatric Infectious Diseases, Gorukle, Bursa, Turkey.

Expert Review of Anti-Infective Therapy
|October 7, 2011
PubMed

Insights

Candidemia in children is a severe hospital-acquired infection with high risks. Diagnosis relies on blood cultures, and treatment typically involves antifungals like fluconazole or echinocandins for non-neutropenic patients.

Area of Science:

  • Medical Mycology
  • Pediatric Infectious Diseases
  • Hospital Epidemiology

Background:

  • Candida species cause diverse infections, from local to systemic, with Candida albicans being most frequent.
  • Invasive fungal infections, particularly candidemia, are significant concerns in pediatric hospital settings, leading to high morbidity, mortality, and healthcare costs.
  • Risk factors for candidemia in children include prolonged intensive care unit stays, immunosuppression, and various medical interventions like central venous catheters and mechanical ventilation.

Purpose of the Study:

  • To review the epidemiology, diagnosis, and management of invasive Candida infections in pediatric patients.
  • To highlight the diagnostic challenges and therapeutic recommendations for candidemia and other invasive Candida infections in children.
  • To clarify the role of diagnostic tests and the indications for antifungal therapy and prophylaxis.

Main Methods:

  • Review of current literature on Candida infections in pediatric populations.
  • Analysis of diagnostic criteria, including the gold standard of blood cultures for candidemia.
  • Evaluation of recommended antifungal treatment regimens and prophylaxis strategies.

Main Results:

  • Candidemia is a serious condition in hospitalized children, with specific risk factors identified.
  • Blood cultures are crucial for diagnosing candidemia, distinguishing it from colonization, especially in catheterized patients.
  • Current guidelines recommend fluconazole or echinocandins for invasive candidiasis in non-neutropenic children, with specific therapies for meningitis.

Conclusions:

  • Accurate diagnosis of candidemia in children is critical, with blood cultures being the definitive method.
  • Antifungal therapy should be guided by the specific Candida species, infection site, and patient's immune status.
  • Prophylaxis is generally not recommended for immunocompetent, non-neonatal children, but diagnosis and treatment of invasive infections are paramount.

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