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Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
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In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
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Persistent candidemia in pediatrics: exploring risk factors.

Adriele C Siqueira1, Amanda M M Ferreira2, Stella C S B Silva3

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Persistent candidemia (PC) in children is linked to central venous catheters, parenteral nutrition, and cancer. Early monitoring of pediatric patients is crucial for better outcomes in invasive fungal infections.

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Area of Science:

  • Pediatric Infectious Diseases
  • Mycology
  • Clinical Microbiology

Background:

  • Persistent candidemia (PC) in children is a serious condition with significant morbidity and mortality.
  • Risk factors and clinical impact of pediatric PC are not well-defined.
  • Understanding these factors is crucial for improving patient management.

Purpose of the Study:

  • To identify independent risk factors associated with persistent candidemia in pediatric patients.
  • To analyze the clinical impact and outcomes of PC in children.
  • To investigate the characteristics of Candida isolates from pediatric candidemia cases.

Main Methods:

  • Retrospective analysis of 141 pediatric patients (0-17 years) with candidemia.
  • Data collection included clinical information, central venous catheter presence, parenteral nutrition, and cancer history.
  • Microbial identification (MALDI-TOF MS), biofilm production, antifungal susceptibility, molecular typing, and ERG11 mutation screening were performed.

Main Results:

  • Persistent candidemia occurred in 34.8% of patients.
  • Independent risk factors for PC included central venous catheter, parenteral nutrition, and cancer.
  • Overall 30-day mortality was 23.4%, with candidemia-related mortality at 16.3%.
  • Candida parapsilosis was the most common species; most isolates produced biofilm.
  • One fluconazole-resistant Candida tropicalis isolate had an ERG11 Y257H mutation.

Conclusions:

  • Persistent candidemia in children is associated with host factors and clinical management strategies.
  • Early removal of central venous catheters and vigilant patient monitoring are critical.
  • The etiological agent's characteristics played a lesser role compared to patient-specific factors.