Abstract
Candida species are a common cause of invasive infection in neonates and children. The aim of our study was to evaluate the epidemiology and microbiology of invasive candidiasis (IC) in the largest tertiary Greek pediatric hospital during a 10-year period. A retrospective cohort study was performed from January 2008 to December 2017. Identification of species and antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) methodology. During the study period, 178 cases of IC were recorded. The tissue distribution included blood (87.1%), cerebrospinal (7.9%), peritoneal (3.9%) and pleural fluids (1.1%). Candida albicans and Candida parapsilosis (sensu lato) were the most frequently isolated species (47.8% and 28.7% respectively). From period 2008–2012 to period 2013–2017, a significant decrease in IC rates was detected (0.21 cases/1000 hospitalization days VS 0.11 cases/1000 hospitalization days, P = 0.040), while median minimum inhibitory concentrations (MICs) of amphotericin B were significantly increased for both C. albicans and C. parapsilosis (sl) (P = 0.037 and P = 0.004 respectively). The decrease in IC rates may reflect the increased awareness as well as the effective infection control initiatives and antifungal interventions. However, the significant increase in the MICs for amphotericin B and echinocandins such as caspofungin, raises concerns about their common use as first-line treatment. Epidemiologic monitoring is, therefore, critically important in order to evaluate and optimize therapeutic protocols for IC in pediatric populations.
Highlights
Invasive candidiasis (IC) is considered as a major cause of mortality in neonates and children [1].Today, several factors are considered as unique risk factors for candidemia in pediatric population such as prematurity and intensive care unit admission in neonates as well as neutropenia and hematologic malignancy in children [2]
We describe the epidemiology of invasive candidiasis in neonatal and pediatric populations in the largest tertiary Greek pediatric hospital during a 10-year period
It was shown that median minimum inhibitory concentrations (MICs) of amphotericin B were significantly increased for both C. albicans and
Summary
Invasive candidiasis (IC) is considered as a major cause of mortality in neonates and children [1]. Several factors are considered as unique risk factors for candidemia in pediatric population such as prematurity and intensive care unit admission in neonates as well as neutropenia and hematologic malignancy in children [2]. Pharmacokinetics and diagnostics still have important knowledge gaps to fill in and as a result, consensus guidelines for IC in pediatric populations lack evidence-based recommendations [3,4]. Despite the fact that C. albicans is still considered the most commonly isolated species in IC, the frequency of non-albicans Candida (NAC) has increased during the last years [5]. Geographical differences in epidemiology trends as well as changes in resistance rates have been detected [6,7].
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