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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.
Insights
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.
Background:
Candida species are the most common cause of systemic fungal infections in children. Risk factors for candidemia vary in different patient populations, posing challenges for clinical prediction of infection. We describe the epidemiology and clinical disease of candidemia in children admitted to a tertiary pediatric hospital.
Methods:
Retrospective audit of children ≤18 years of age with candidemia at a tertiary pediatric hospital over a 16-year period.
Results:
There were 139 episodes of candidemia in 124 children. A central venous catheter was present in 94% of episodes, prior antibiotic exposure in 86% and parenteral nutrition in 43%. During the study period, the proportion of candidemia due to non-albicans Candida spp. increased primarily due to a rise in C. krusei. Colonization with Candida spp. in the 30 days before developing candidemia was identified in 40% of episodes and the species was concordant in 60%. Infection at other sites was rare, including pulmonary dissemination (9/38, 24%), renal fungal disease (9/114, 8%), fungal endophthalmitis (8/102, 8%) and hepatosplenic nodules (5/92, 5%). Overall, 8/127 (6%) isolates were fluconazole-resistant (7 C. krusei and 1 C. glabrata) and 7/127 (6%) had intermediate susceptibility to fluconazole. The overall 30-day mortality was 12% and significant risk factors for mortality on multivariate analysis were male sex, liver disease and mucositis.
Conclusions:
Our study outlines low rates of disseminated candidiasis and low mortality associated with candidemia at our institution. Additionally, it suggests that prior colonization may be an important risk factor, however, this should be validated in large prospective controlled studies.
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