Results From a Prospective, International, Epidemiologic Study of Invasive Candidiasis in Children and Neonates.

Pediatr Infect Dis J. 2012 Dec;31(12):1252-1257.

Results From a Prospective, International, Epidemiologic Study of Invasive Candidiasis in Children and Neonates.

Steinbach WJRoilides EBerman DHoffman JAGroll AHBin-Hussain IPalazzi DLCastagnola EHalasa NVelegraki ADvorak CCCharkabarti ASung L,Danziger-Isakov LLachenauer CArrieta AKnapp KAbzug MJZiebold CLehrnbecher TKlingspor LWarris ALeckerman KMartling TWalsh TJBenjamin DK JrZaoutis TEthe International Pediatric Fungal Network.


From * Duke University, Durham, NC; †3rd Department of Pediatrics, Aristotle University and Hippokration Hospital, Thessaloniki, Greece; ‡All Children’s Hospital, St. Petersburg, FL; §Children’s Hospital Los Angeles, Los Angeles, CA; ¶Department of Pediatric Hematology/Oncology, University Children’s Hospital, Muenster, Germany; ║King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia; **Baylor College of Medicine and Texas Children’s Hospital, Houston, TX; ††»G. Gaslini» Children’s Hospital, Genoa, Italy; ‡‡Vanderbilt University, Nashville, TN; §§Microbiology Department, Medical School, University of Athens, Athens, Greece; ¶¶University of California-San Francisco, San Francisco, CA; ║║Postgraduate Institute of Medical Education and Research, Chandigarh, India; ***Hospital for Sick Children, Toronto, Ontario, Canada; †††Cleveland Clinic, Cleveland, OH; ‡‡‡Children’s Hospital Boston, Boston, MA; §§§Children’s Hospital-Orange County, Orange, CA; ¶¶¶St. Jude Children’s Hospital, Memphis, TN; ║║║University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO; ****University of Iowa Children’s Hospital, Iowa City, IA; ††††Johann Wolfgang Goethe University, Frankfurt, Germany; ‡‡‡‡Karolinska University Hospital, Stockholm, Sweden; §§§§Department of Pediatrics, Radboud University Nijmegen Medical Center, the Netherlands; ¶¶¶¶Children’s Hospital of Philadelphia, Philadelphia, PA; and ║║║║Weill Cornell Medical Center, New York, NY.


BACKGROUND:: Candida species are the third most common cause of pediatric health care-associated bloodstream infection in the United States and Europe. To our knowledge, this report from the International Pediatric Fungal Network is the largest prospective, multicenter observational study dedicated to pediatric and neonatal invasive candidiasis. METHODS:: From 2007 to 2011, we enrolled 196 pediatric and 25 neonatal patients with invasive candidiasis. RESULTS:: Non-albicans Candida species predominated in pediatric (56%) and neonatal (52%) age groups, yet Candida albicans was the most common species in both groups. Successful treatment responses were observed in pediatric (76%) and neonatal patients (92%). Infection with Candida parapsilosis led to successful responses in pediatric (92%) and neonatal (100%) patients, whereas infection with Candida glabrata was associated with a lower successful outcome in pediatric patients (55%). The most commonly used primary antifungal therapies for pediatric invasive candidiasis were fluconazole (21%), liposomal amphotericin B (20%) and micafungin (18%). Outcome of pediatric invasive candidiasis was similar in response to polyenes (73%), triazoles (67%) and echinocandins (73%). The most commonly used primary antifungal therapies for neonatal invasive candidiasis were fluconazole (32%), caspofungin (24%) and liposomal amphotericin B (16%) and micafungin (8%). Outcomes of neonatal candidiasis by antifungal class again revealed similar response rates among the classes. CONCLUSIONS:: We found a predominance of non-albicans Candida infection in children and similar outcomes based on antifungal class used. This international collaborative study sets the foundation for large epidemiologic studies focusing on the unique features of neonatal and pediatric candidiasis and comparative studies of therapeutic interventions in these populations.





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