Results from a prospective, international, epidemiologic study of invasive candidiasis in children and neonates.

Abstract

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.

• Authors: William J Steinbach, Emmanuel Roilides, David Berman, Jill A Hoffman, Andreas H Groll, Ibrahim Bin-Hussain, Debra L Palazzi, Elio Castagnola, Natasha Halasa, Aristea Velegraki, Christopher C Dvorak, Arunaloke Charkabarti, Lillian Sung, Lara Danziger-Isakov, Catherine Lachenauer, Antonio Arrieta, Katherine Knapp, Mark J Abzug, Christine Ziebold, Thomas Lehrnbecher, Lena Klingspor, Adilia Warris, Kateri Leckerman, Teresa Martling, Thomas J Walsh, Daniel K Benjamin Jr, Theoklis E Zaoutis, International Pediatric Fungal Network
• Journal: The Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 31 Issue 12 Pg. 1252-7 (Dec 2012) ISSN: 1532-0987 [Electronic] United States
• PMID: 22982980 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antifungal Agents

Topics

• Adolescent
• Antifungal Agents (administration & dosage)
• Candida (classification, isolation & purification)
• Candidiasis, Invasive (drug therapy, epidemiology, microbiology)
• Child
• Child, Preschool
• Epidemiologic Studies
• Europe (epidemiology)
• Female
• Humans
• Infant
• Infant, Newborn
• International Cooperation
• Male
• Prospective Studies
• Treatment Outcome
• United States (epidemiology)