Abstract
Pediatric patients present with differing underlying conditions and cytotoxic therapeutic protocols, so the differing epidemiology of invasive candidiasis in children versus adults is not surprising. Understanding the Candida species epidemiology is critical, as we often begin empiric therapy or therapy before antifungal susceptibilities are known. Reports with newer molecular diagnostic assays for invasive candidiasis are rare and require more study to develop firm pediatric-specific guidance. Antifungal treatment of pediatric candidiasis is reviewed in the context of larger epidemiologic studies and the few trials completed to date.
Highlights
Candida species are a major contributor to morbidity and mortality in hospitalized children
All-cause mortality associated with pediatric candidiasis exceeds 15%, with an attributable mortality of 10% [8]
While aspects of pediatric and adult invasive candidiasis are similar, numerous studies have revealed critical differences in host factors, pharmacokinetics, and outcomes in children that underscore the importance of dedicated pediatric studies [8,11,12,13,14,15]
Summary
Candida species are a major contributor to morbidity and mortality in hospitalized children. The single center model determined that presence of a central venous catheter (CVC), recent exposure to certain antimicrobial agents (vancomycin, anti-anaerobic agents), recent exposure to parenteral nutrition, and underlying malignancy resulted in a predictive probability for candidemia of 46% (95% CI: 19%–75%) To validate this model, a prospective, multi-center case-control study was performed at six free standing pediatric institutions [18]. Significant variation was noted across the six participating sites in exposure to each of the five predictor variables among cases and controls and only presence of a CVC was associated with subsequent candidemia in univariate analysis (OR: 9.6; 95% CI: 3.4%–27.3%) This multi-center validation study was unsuccessful due to significant variability in predictors across hospitals and across time. There have been prospective multi-center studies regarding pediatric invasive candidiasis in specific regions of the world [21,22,23], but additional research is needed to fill important knowledge gaps in pediatric candidiasis
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