Abstract
In this paper, our aim was to investigate the incidence, clinical characteristics, risk factors, and outcomes of recurrent candidemia in children. We retrospectively reviewed all children with candidemia from a medical center in Taiwan between 2004 and 2015. Two episodes of candidemia ≥30 days apart with clinical and microbiological resolution in the interim were defined as “late recurrence”, and those that had 8–29 days apart from previous episodes were defined as “early recurrence”. 45 patients (17.2%) had 57 episodes of recurrent candidemia, and 24 had 28 episodes of late recurrent candidemia. The median time between recurrences was 1.8 months (range: <1 month to 13 months). Of those, 29 had relapsed candidemia and 28 were re-infected by different Candida species (n = 24) or by different strains (n = 4). Recurrent candidemia patients were more likely to require echinocandins treatment, had a longer duration of candidemia, and higher rate of treatment failure (p = 0.001, 0.014, and 0.012, respectively). Underlying gastrointestinal diseases (Odds ratio (OR) 3.84; 95% Confidence interval (CI) 1.81–8.12) and neurological sequelae (OR 2.32; 95% CI 1.15–4.69) were independently associated with the development of recurrent candidemia. 17.2% of pediatric patients with candidemia developed recurrent candidemia, and approximately half were re-infected. Underlying gastrointestinal diseases and neurological sequelae were the independent risk factors for recurrent candidemia.
Highlights
Candida species have become the fourth most common cause of nosocomial bloodstream infections since more than two decades ago [1]
Between January 2003 and December 2015, 262 patients less than 18 years old developed a total of 319 episodes of candidemia at CGMH
We found that 17.2% of pediatric patients who survived the first episode of candidemia had recurrent candidemia, and 9.2% had late recurrence
Summary
Candida species have become the fourth most common cause of nosocomial bloodstream infections since more than two decades ago [1]. Candidemia is associated with significant morbidity and contributes to important in-hospital mortality, especially among critically ill patients [2,3,4]. Most pediatric patients with candida bloodstream infections have severe underlying diseases, the presence of artificial devices, surgical risk factors, or are frequently exposed to high-risk medications [5,6,7,8,9]. Updated information of pediatric candidemia shows that emerging Candida isolates are nonsusceptible to fluconazole, a trend toward non-albicans Candida preponderance, and they still have high mortality [8,12,13,14,15].
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