Candidemia mortality in children low, tied to liver disease, male sex

A 16-year longitudinal epidemiologic study has found low rates of disseminated candidiasis and low mortality associated with candidemia at a tertiary paediatric hospital.

In addition, prior colonization appears to be a significant risk factor, but this warrants further validation in large prospective controlled studies.

The authors performed a retrospective audit of children aged ≤18 years with candidemia at a tertiary paediatric hospital over a 16-year period. A total of 139 candidemia episodes were noted in 124 children. A central venous catheter was present in 94 percent of episodes, prior antibiotic exposure in 86 percent, and parenteral nutrition in 43 percent.

There was an increase in the proportion of candidemia due to nonalbicans Candida spp. during the study period mainly because of a risk in C. krusei. Colonization with Candida spp. in the 30 days prior to developing candidemia was identified in 40 percent of episodes, and the species was concordant in 60 percent.

Although rare, infection at other sites occurred, such as pulmonary dissemination (9/38, 24 percent), renal fungal disease (9/14, 8 percent), fungal endophthalmitis (8/102, 8 percent), and hepatosplenic nodules (5/92, 5 percent).

In general, 8/127 (6 percent) isolates were resistant to fluconazole (seven C. krusei and one C. glabrata) and 7/127 (6 percent) had intermediate susceptibility to fluconazole.

The overall 30-day mortality stood at 12 percent. In multivariate analysis, the risk of mortality was significantly associated with male sex, liver disease, and mucositis.

“Candida species are the most common cause of systemic fungal infections in children,” the authors said. “Risk factors for candidemia vary in different patient populations, posing challenges for clinical prediction of infection.”