Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates

BMC Infect Dis. 2018 Apr 24;18(1):194. doi: 10.1186/s12879-018-3100-2.

Abstract

Background: Invasive candidiasis differs greatly between children and neonates. We aimed to investigate the different therapeutic approaches and their effects on treatment outcomes of these two groups.

Methods: Episodes of neonatal invasive candidiasis were compared with non-neonatal pediatric episodes during a 12-year cohort study. Clinical isolates were documented by matrix-assisted laser desorption/ionization-time of flight mass spectrometry and DNA sequencing, and antifungal susceptibility testing was performed.

Results: A total of 342 episodes of invasive candidiasis (113 neonatal and 229 non-neonatal pediatric episodes) in 281 pediatric patients (96 neonates and 185 children) were identified. Candida albicans was the most common pathogen causing invasive candidiasis in neonates and children (47.8% vs. 44.1%). The antifungal susceptibility profiles were not significantly different between neonates and children. More neonates received amphotericin B as therapy, whereas more children received fluconazole or caspofungin. Compared with children, neonates had a significantly longer duration of fungemia, higher rates of septic shock (34.5% vs. 21.8%; P = 0.013), sepsis-attributable mortality (28.3% vs. 17.5%; P = 0.024) and in-hospital mortality (42.7% vs. 25.4%; P = 0.004) than children. Independent risk factors for treatment failure of invasive candidiasis were septic shock (odds ration [OR] 16.01; 95% confidence interval [CI] 7.64-33.56; P < 0.001), delayed removal of intravenous catheter (OR 6.78; 95% CI 2.80-17.41; P < 0.001), renal failure (OR 5.38; 95% CI 1.99-14.57; P = 0.001), and breakthrough invasive candidiasis (OR 2.99; 95% CI 1.04-8.67; P = 0.043).

Conclusions: Neonatal invasive candidiasis has worse outcomes than non-neonatal pediatric candidiasis. Neonatologists and pediatricians must consider age-specific differences when developing treatment and prevention guidelines, or when interpreting studies of other age groups.

Keywords: Antifungal susceptibility; Bloodstream infection; Candidemia; Invasive candidiasis; Mortality.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Amphotericin B / therapeutic use
  • Antifungal Agents / therapeutic use*
  • Candida albicans / pathogenicity
  • Candidiasis, Invasive / drug therapy*
  • Candidiasis, Invasive / epidemiology*
  • Candidiasis, Invasive / etiology
  • Caspofungin / therapeutic use
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Fluconazole / therapeutic use
  • Fungemia / drug therapy
  • Fungemia / epidemiology
  • Fungemia / microbiology*
  • Hospital Mortality
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Risk Factors
  • Taiwan / epidemiology
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Amphotericin B
  • Fluconazole
  • Caspofungin