Abstract
We aimed to determine the clinical and microbiological characteristics of Candida bloodstream infections in children and the impact of therapeutic strategies on outcomes. All pediatric patients with candidemia from a medical center in Taiwan over a 13-year period (2003–2015) were included and a total of 262 patients with 319 episodes of candidemia were analyzed. Overall susceptibility to fluconazole was 86.1%. Cumulative mortality at 7 and 30 days after the first episode of candidemia was 13.4% and 25.2%, respectively. The overall in-hospital mortality rate was 35.1%. The treatment outcomes did not change over the study period. Multivariate analysis showed that delayed catheter removal (odds ratio [OR], 5.52; 95% confidence interval [CI]: 2.97–10.25), septic shock (OR, 5.49; 95% CI: 2.85–10.57), and breakthrough candidemia (OR, 3.66; 95% CI: 1.43–9.35) were independently associated with clinical treatment failure. In children with candidemia, underlying renal insufficiency and hematological/oncological malignancy, delayed catheter removal, and septic shock at onset were independently associated final in-hospital mortality. Analyzing the subgroup of non-neonatal children did not change the findings. We concluded overall mortality of pediatric candidemia remains high during the past decade. Prompt early catheter removal and aggressive treatment strategy in patients with septic shock would be critical to improve outcomes.
Highlights
Candida bloodstream infection (BSI) is associated with high mortality and morbitidy rates among critically ill patients[1, 2]
There is relatively scarce information regarding the impact of specific therapeutic strategies on an adverse outcome of pediatric candidemia[6, 27, 28], as the authors of recent cohort studies did not analyze the influence of illness severity, catheter removal and timing of antifungal treatments[11, 28]
These studies did not consider the effectiveness of antifungal agents based on in vitro antifungal susceptibility, and the second or recurrent episodes were often ignored[4, 10, 11, 28]
Summary
Candida bloodstream infection (BSI) is associated with high mortality and morbitidy rates among critically ill patients[1, 2]. Numerous studies have described the epidemiology, clinical features, antifungal treatment and outcomes of children with candidemia[4, 10,11,12,13,14,15,16]. Studies of pediatric candidemia were often limited by small sample sizes[4, 14], lack of antifungal susceptibility testing[4, 13, 16], or did not analyze the impact of different treatment strategies on outcome[4, 15, 16]. Candida BSI in children, to present the results of antifungal susceptibility testing, and to assess the influences of therapeutic measures on the prognosis
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