Scientific article

Candidemia in children : a 16-year longitudinal epidemiologic study

Published inThe pediatric infectious disease journal, vol. 40, no. 6, p. 537-543
Publication date2021-06-01

Background: Candida species are the most common cause of systemic fungal infections in children. Risk factors for candidemia vary in different patient populations, posing challenges for clinical prediction of infection. We describe the epidemiology and clinical disease of candidemia in children admitted to a tertiary pediatric hospital.

Methods: Retrospective audit of children ≤18 years of age with candidemia at a tertiary pediatric hospital over a 16-year period.

Results: There were 139 episodes of candidemia in 124 children. A central venous catheter was present in 94% of episodes, prior antibiotic exposure in 86% and parenteral nutrition in 43%. During the study period, the proportion of candidemia due to non-albicans Candida spp. increased primarily due to a rise in C. krusei. Colonization with Candida spp. in the 30 days before developing candidemia was identified in 40% of episodes and the species was concordant in 60%. Infection at other sites was rare, including pulmonary dissemination (9/38, 24%), renal fungal disease (9/114, 8%), fungal endophthalmitis (8/102, 8%) and hepatosplenic nodules (5/92, 5%). Overall, 8/127 (6%) isolates were fluconazole-resistant (7 C. krusei and 1 C. glabrata) and 7/127 (6%) had intermediate susceptibility to fluconazole. The overall 30-day mortality was 12% and significant risk factors for mortality on multivariate analysis were male sex, liver disease and mucositis.

Conclusions: Our study outlines low rates of disseminated candidiasis and low mortality associated with candidemia at our institution. Additionally, it suggests that prior colonization may be an important risk factor, however, this should be validated in large prospective controlled studies.

  • Adolescent
  • Candida / drug effects
  • Candidemia / epidemiology
  • Candidemia / mortality
  • Child
  • Child, Preschool
  • Drug Resistance, Fungal
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Retrospective Studies
  • Risk Factors
  • Tertiary Care Centers / statistics & numerical data
Affiliation Not a UNIGE publication
Citation (ISO format)
SILVESTER, Eloise J et al. Candidemia in children : a 16-year longitudinal epidemiologic study. In: The pediatric infectious disease journal, 2021, vol. 40, n° 6, p. 537–543. doi: 10.1097/INF.0000000000003082
Main files (1)
Article (Published version)
ISSN of the journal0891-3668

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