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

Jen Fu Hsu, Mei Yin Lai, Chiang Wen Lee, Shih Ming Chu, I. Hsyuan Wu, Hsuan Rong Huang, I-Ta Lee, Ming Chou Chiang, Ren Huei Fu, Ming Horng Tsai

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish
Article number194
JournalBMC Infectious Diseases
Volume18
Issue number1
DOIs
Publication statusPublished - Apr 24 2018
Externally publishedYes

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Invasive Candidiasis
Newborn Infant
Incidence
Confidence Intervals
Pediatrics
Septic Shock
caspofungin
Fungemia
Fluconazole
Candidiasis
Amphotericin B
Hospital Mortality
Treatment Failure
Candida albicans
DNA Sequence Analysis
Renal Insufficiency
Mass Spectrometry
Sepsis
Lasers
Cohort Studies

Keywords

  • Antifungal susceptibility
  • Bloodstream infection
  • Candidemia
  • Invasive candidiasis
  • Mortality

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Hsu, J. F., Lai, M. Y., Lee, C. W., Chu, S. M., Wu, I. H., Huang, H. R., ... Tsai, M. H. (2018). Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates. BMC Infectious Diseases, 18(1), [194]. https://doi.org/10.1186/s12879-018-3100-2

Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates. / Hsu, Jen Fu; Lai, Mei Yin; Lee, Chiang Wen; Chu, Shih Ming; Wu, I. Hsyuan; Huang, Hsuan Rong; Lee, I-Ta; Chiang, Ming Chou; Fu, Ren Huei; Tsai, Ming Horng.

In: BMC Infectious Diseases, Vol. 18, No. 1, 194, 24.04.2018.

Research output: Contribution to journalArticle

Hsu, Jen Fu ; Lai, Mei Yin ; Lee, Chiang Wen ; Chu, Shih Ming ; Wu, I. Hsyuan ; Huang, Hsuan Rong ; Lee, I-Ta ; Chiang, Ming Chou ; Fu, Ren Huei ; Tsai, Ming Horng. / Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates. In: BMC Infectious Diseases. 2018 ; Vol. 18, No. 1.
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AU - Wu, I. Hsyuan

AU - Huang, Hsuan Rong

AU - Lee, I-Ta

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N2 - 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.

AB - 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.

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