Epidemiology, risk factors and therapy of candidemia in pediatric hematological patients

Area of Science:

• Pediatric Critical Care Medicine
• Infectious Diseases
• Mycology

Background:

• Invasive fungal infections (IFI) contribute to significant morbidity, hospitalization, and healthcare costs in critically ill or immunocompromised children.
• Mortality rates for IFI in children range from 5% to 20%.
• Recent decades show a shift in candidemia epidemiology, with a rise in non-Candida albicans species.

Purpose of the Study:

• To review the epidemiology and risk factors of invasive fungal infections in pediatric populations.
• To outline current recommendations for early antifungal treatment strategies.
• To discuss optimal antifungal choices based on fungal species and patient characteristics.

Main Methods:

• Literature review of invasive fungal infections in pediatric intensive care units (PICUs).
• Analysis of risk factors associated with candidemia in critically ill children.
• Evaluation of current antifungal treatment guidelines and drug efficacy.

Main Results:

• Key risk factors for candidemia in the PICU include central venous catheters, malignancy, and prolonged use of certain antimicrobials.
• Hematological patients face additional risks such as aplastic anemia, transplants, graft-versus-host disease, and steroid use.
• Recommended first-line treatments for neutropenic patients include liposomal amphotericin B, echinocandins, and voriconazole, particularly for non-albicans Candida species.

Conclusions:

• Early diagnosis and prompt antifungal treatment are essential for improving outcomes in pediatric invasive fungal infections.
• Treatment choices should be guided by the specific Candida species and prior patient exposure to antifungals.
• Amphotericin B deoxycholate is generally avoided due to its nephrotoxicity.