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Candidemia in a pediatric population
1Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois 60135, USA.
Abstract:
Candidemia results in a mortality of > 50% among adults, but data on children with candidemia are limited. We reviewed 70 episodes of pediatric candidemia that occurred between January 1988 and October 1992. Of these episodes, 53% were caused by Candida albicans, 24% were caused by Candida parapsilosis, 16% were caused by Candida tropicalis, and 3% were caused by Candida krusei. Twenty-five percent of the patients were premature infants. Other underlying conditions included malignancy (15%); cardiac disease (14%); and short-gut syndrome (14%). A central venous catheter was in place during 61 (87%) of 70 episodes. Candiduria preceded candidemia in only 4 (8%) of 52 patients. The overall mortality rate was 19%; 36% of those with intravenous catheters that were not removed within 3 days died, whereas none of the patients from whom catheters were removed within 3 days died (P < .0001). Only two survivors had complications. Therapy with amphotericin B (with or without flucytosine) was administered to 74% of these patients. Seventeen patients were not treated medically; all were immunocompetent and survived. Of these patients, 15 were > 2 months of age; 14 had candidemia for < or = 2 days; and 15 had an intravenous catheter removed within 2 days of the onset of candidemia. No patient stopped receiving amphotericin B because of side effects. The results of this study suggest the following: that mortality associated with candidemia is lower among children than among adults; that failure to remove the indwelling intravenous catheter usually results in a poor outcome; that candiduria rarely precedes candidemia in children; and that amphotericin B is well tolerated by children.
Insights
Pediatric candidemia has lower mortality than in adults. Prompt removal of central venous catheters significantly improves survival, and amphotericin B is well-tolerated in children.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Candidemia poses a significant mortality risk in adults, yet pediatric data remain limited.
- Candida species are a common cause of bloodstream infections in neonates and children.
- Understanding risk factors and outcomes in pediatric candidemia is crucial for effective management.
Purpose of the Study:
- To analyze the epidemiology, clinical features, and outcomes of pediatric candidemia.
- To identify factors associated with mortality in children with candidemia.
- To evaluate the efficacy and tolerability of antifungal therapy in pediatric patients.
Main Methods:
- Retrospective review of 70 pediatric candidemia episodes from January 1988 to October 1992.
- Analysis of causative Candida species, patient demographics, underlying conditions, and treatment modalities.
- Assessment of the impact of central venous catheter management and antifungal therapy on patient outcomes.
Main Results:
- Candida albicans was the most common species (53%), followed by C. parapsilosis (24%) and C. tropicalis (16%).
- Premature infants and patients with malignancy, cardiac disease, or short-gut syndrome were frequently affected.
- Mortality rate was 19%; catheter removal within 3 days was associated with significantly better survival (P < .0001).
- Amphotericin B was used in 74% of treated patients and was well-tolerated; 17 immunocompetent patients survived without antifungal treatment.
Conclusions:
- Pediatric candidemia has a lower mortality rate compared to adults.
- Timely removal of central venous catheters is critical for improving survival in pediatric candidemia.
- Candiduria is an infrequent precursor to candidemia in children.
- Amphotericin B demonstrates good tolerability and efficacy in treating pediatric candidemia.