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

doi:10.1186/s12879-018-3100-2

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 journal › Article › peer-review

28 Citations (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 language	English
Article number	194
Journal	BMC Infectious Diseases
Volume	18
Issue number	1
DOIs	https://doi.org/10.1186/s12879-018-3100-2
Publication status	Published - Apr 24 2018
Externally published	Yes

Keywords

Antifungal susceptibility
Bloodstream infection
Candidemia
Invasive candidiasis
Mortality

ASJC Scopus subject areas

Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s12879-018-3100-2

Cite this

@article{6e62c8ca96994d2bab2826b8393f451c,

title = "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 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.",

keywords = "Antifungal susceptibility, Bloodstream infection, Candidemia, Invasive candidiasis, Mortality",

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

note = "Funding Information: The abstract has been previously published as a conference abstract and accepted as the poster presentation in 2nd Congress of joint European Neonatal Societies (jENS 2017) Session “Neonatal Infectious Diseases/ Immunology” Venice, Italy in October 30– November 4, 2017. All authors thank financial support from the Chang Gung Medical Research Program Foundation (grants CMRPG3E1491). We thank Professor Jang-Jih Lu (Department of Laboratory Medicine, Department of Medical Biotechnology and Laboratory Science Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan) for providing the technical support of all Candida isolates re-identification and antifungal susceptibility testing. Publisher Copyright: {\textcopyright} 2018 The Author(s).",

year = "2018",

month = apr,

day = "24",

doi = "10.1186/s12879-018-3100-2",

language = "English",

volume = "18",

journal = "BMC Infectious Diseases",

issn = "1471-2334",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

T1 - Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates

AU - Hsu, Jen Fu

AU - Lai, Mei Yin

AU - Lee, Chiang Wen

AU - Chu, Shih Ming

AU - Wu, I. Hsyuan

AU - Huang, Hsuan Rong

AU - Lee, I-Ta

AU - Chiang, Ming Chou

AU - Fu, Ren Huei

AU - Tsai, Ming Horng

N1 - Funding Information: The abstract has been previously published as a conference abstract and accepted as the poster presentation in 2nd Congress of joint European Neonatal Societies (jENS 2017) Session “Neonatal Infectious Diseases/ Immunology” Venice, Italy in October 30– November 4, 2017. All authors thank financial support from the Chang Gung Medical Research Program Foundation (grants CMRPG3E1491). We thank Professor Jang-Jih Lu (Department of Laboratory Medicine, Department of Medical Biotechnology and Laboratory Science Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan) for providing the technical support of all Candida isolates re-identification and antifungal susceptibility testing. Publisher Copyright: © 2018 The Author(s).

PY - 2018/4/24

Y1 - 2018/4/24

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.

KW - Antifungal susceptibility

KW - Bloodstream infection

KW - Candidemia

KW - Invasive candidiasis

KW - Mortality

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U2 - 10.1186/s12879-018-3100-2

DO - 10.1186/s12879-018-3100-2

M3 - Article

AN - SCOPUS:85046012390

SN - 1471-2334

VL - 18

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

M1 - 194

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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