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Deprecated: Implicit conversion from float 267.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 BMC+Infect+Dis 2018 ; 18 (ä): ä Nephropedia Template TP
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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[]; 18 (ä): ä PMID29699503show 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.