Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates
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 pediatri...
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://link.springer.com/article/10.1186/s12879-018-3100-2 |
| _version_ | 1828874480430088192 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Jen-Fu Hsu |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T07:38:12Z |
| format | Article |
| id | doaj.art-1334b4aa982a4c799c48fbab47a88995 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-13T07:38:12Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-1334b4aa982a4c799c48fbab47a889952022-12-21T23:55:01ZengBMCBMC Infectious Diseases1471-23342018-04-0118111110.1186/s12879-018-3100-2Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonatesJen-Fu Hsu0Mei-Yin Lai1Chiang-Wen Lee2Shih-Ming Chu3I-Hsyuan Wu4Hsuan-Rong Huang5I-Ta Lee6Ming-Chou Chiang7Ren-Huei Fu8Ming-Horng Tsai9Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial HospitalDivision of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial HospitalDepartment of Nursing, Division of Basic Medical Sciences and Research Center for Industry of Human Ecology, Chang Gung University of Science and TechnologyDivision of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial HospitalDivision of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial HospitalDivision of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial HospitalDepartment of Medical Research, Taichung Veterans General HospitalDivision of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial HospitalDivision of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial HospitalDivision of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial HospitalAbstract 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.http://link.springer.com/article/10.1186/s12879-018-3100-2Bloodstream infectionInvasive candidiasisCandidemiaAntifungal susceptibilityMortality |
| spellingShingle | 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 Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates BMC Infectious Diseases Bloodstream infection Invasive candidiasis Candidemia Antifungal susceptibility Mortality |
| title | Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates |
| title_full | Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates |
| title_fullStr | Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates |
| title_full_unstemmed | Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates |
| title_short | Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates |
| title_sort | comparison of the incidence clinical features and outcomes of invasive candidiasis in children and neonates |
| topic | Bloodstream infection Invasive candidiasis Candidemia Antifungal susceptibility Mortality |
| url | http://link.springer.com/article/10.1186/s12879-018-3100-2 |
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