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Updated: Feb 26, 2026
An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Candidemia and invasive candidiasis among hospitalized neonates and pediatric patients
Rachel Harrington1, Sylvia L Kindermann2, Qingjiang Hou3
1a At time of study Astellas Pharma Global Development Inc. , Northbrook , IL , USA.
Insights
Invasive candidiasis in children significantly increases hospital stays and costs. Early antifungal treatment may improve outcomes and reduce resource use in pediatric patients.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Healthcare Epidemiology
Background:
- Invasive candidiasis (IC) presents a significant challenge in neonatal and pediatric populations.
- Understanding the epidemiology, treatment patterns, and economic impact of IC is crucial for optimizing patient care.
Purpose of the Study:
- To investigate the epidemiology, treatment, length of stay (LOS), and costs associated with invasive candidiasis in neonatal and pediatric inpatients.
- To identify factors influencing LOS and healthcare costs in pediatric patients with candidemia.
Main Methods:
- Utilized the Cerner Health Facts Database to analyze inpatient data from 2005-2014.
- Identified patients with positive blood or cerebrospinal fluid Candida cultures.
- Employed multivariable linear regression to examine log-transformed LOS and cost in candidemia-only patients.
Main Results:
- A total of 202 patients were identified, with Candida parapsilosis and Candida albicans being the most prevalent species.
- Common comorbidities included sepsis, coagulation disorders, and cancer.
- Mean LOS was 45.6 days, mean cost was $97,392, and mortality was 9.9%.
- Factors associated with increased LOS included ICU exposure, central catheter, sepsis, and early antifungal administration.
- Increased cost was linked to early antifungal use, in-hospital mortality, and ventricular shunts.
Conclusions:
- Pediatric candidemia is associated with substantial increases in resource utilization and LOS.
- A significant proportion of patients received delayed or no antifungal therapy, indicating a potential area for improved treatment strategies.
- Optimizing antifungal treatment protocols may lead to better outcomes and reduced healthcare expenditures in pediatric invasive candidiasis.
Objective:
To investigate the epidemiology, treatment, length of stay (LOS) and costs for neonatal and pediatric inpatients with invasive candidiasis (IC).
Methods:
The Cerner Health Facts Database was used to assess inpatients (2005-2014) identified by positive blood or cerebrospinal fluid (CSF) Candida cultures. Log-transformed LOS and cost were examined in candidemia-only patients (n = 191) using multivariable linear regression.
Results:
A total of 202 patients had a positive culture (blood: n = 192; CSF: n = 10; both: n = 2). The most prevalent species were C. parapsilosis (n = 70, 34.7%), and C. albicans (n = 66, 32.7%). Mean (SD) age was 5 (5.5) years; 30 (14.9%) patients were <4 months. Comorbidities included sepsis (n = 85, 42.1%), coagulation disorders (n = 57, 28.2%), cancer (n = 64, 31.7%), and low birthweight (n = 26, 12.9%). Antifungals (AFs) included azoles (57.4%), polyenes (28.7%), and echinocandins (35.1%); 20.8% of patients received no AF during their encounter. The mean (SD) cost per encounter was $97,392 ($149,253), with a mean (SD) LOS of 45.6 (59.5) days and 9.9% mortality at discharge. Results were similar across Candida species. In regression analysis, intensive care unit (ICU) exposure, central catheter, sepsis, AF >48 hours prior to index culture, and age <4 months were associated with increased LOS; treatment at a non-teaching hospital was associated with reduced LOS (p < .05). AF use >48 hours before index, in-hospital mortality, Midwest region and ventricular shunt were associated with increased cost (p ≤ .05).
Conclusions:
This analysis confirms the association between pediatric candidemia and increased resource utilization and LOS. Given high observed rates of potential under-treatment, an opportunity may exist to improve AF therapy in this population.
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