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Candidemia in Children: A 16-year Longitudinal Epidemiologic Study
Eloise J Silvester1,2, Melissa M Y Watanabe2, Laure F Pittet2
1From the Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia.
The Pediatric Infectious Disease Journal
|February 16, 2021
Summary
Pediatric candidemia, a common fungal infection, showed increased non-albicans Candida species, particularly Candida krusei. Prior colonization may predict infection, with low disseminated disease rates and mortality observed.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Clinical Epidemiology
Background:
- Candida species are a leading cause of systemic fungal infections in children.
- Predicting candidemia (Candida bloodstream infection) is challenging due to varying risk factors across patient groups.
- This study examines the epidemiology and clinical presentation of candidemia in a pediatric hospital setting.
Purpose of the Study:
- To describe the epidemiology of candidemia in children admitted to a tertiary pediatric hospital.
- To identify risk factors and clinical outcomes associated with candidemia in pediatric patients.
- To analyze trends in Candida species causing infection and their antifungal susceptibility.
Main Methods:
- A retrospective audit of all children (≤18 years) diagnosed with candidemia over a 16-year period.
- Data collection included patient demographics, risk factors (central venous catheter, antibiotics, parenteral nutrition), Candida species, antifungal susceptibility, and clinical outcomes.
- Analysis focused on identifying trends, risk factors for mortality, and rates of disseminated infection.
Main Results:
- 139 episodes of candidemia occurred in 124 children, with central venous catheters (94%), prior antibiotics (86%), and parenteral nutrition (43%) as common factors.
- Non-albicans Candida species, notably Candida krusei, increased over time.
- Prior Candida colonization (40% of episodes) was common, with concordance in 60%; disseminated infections were rare (e.g., pulmonary 24%, renal 8%).
- Fluconazole resistance was observed in 6% of isolates (primarily C. krusei). Overall 30-day mortality was 12%, with male sex, liver disease, and mucositis as significant risk factors.
Conclusions:
- Candidemia in this pediatric cohort was associated with low rates of disseminated disease and mortality.
- Prior Candida colonization may serve as a significant predictive factor for candidemia.
- Further prospective studies are recommended to validate the role of colonization as a risk factor.
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