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2018 ; 18
(1
): 194
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Comparison of the incidence, clinical features and outcomes of invasive
candidiasis in children and neonates
#MMPMID29699503
Hsu JF
; Lai MY
; Lee CW
; Chu SM
; Wu IH
; Huang HR
; Lee IT
; Chiang MC
; Fu RH
; Tsai MH
BMC Infect Dis
2018[Apr]; 18
(1
): 194
PMID29699503
show ga
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.