Recent changes in candidemia trends in a tertiary hospital (2011–2018);

Autores de IIS La Fe

• Ana Isabel Piqueras Arenas

  Autor

• Eva Maria López Medina

  Autor

• Ana Gimeno Navarro

  Autor

• Vicent Modesto Alapont

  Autor

• Emilia Canton Lacasa

  Autor

• Javier Pemán García

  Autor

Participantes ajenos a IIS La Fe

• Rubio T.

Grupos

• Infección Grave

• Perinatología

Abstract

Background: The epidemiology of candidemia has changed over the last decades and varies widely among geographic areas. Aims: We examined in children (aged 0–14) with candidemia the trends in the incidence rate of this infection, as well as the clinical characteristics of the patients, in order to optimize the prognosis and the control measures of this serious disease. Methods: A retrospective cohort study of candidemia in the period 2011–2018 in the neonatal intensive care unit (NICU), pediatric ICU (PICU) and pediatric wards of a tertiary hospital, was conducted. The clinical course, Candida species isolated, antifungal susceptibility, outcome and incidence rates were analyzed and compared. Results: We diagnosed 68 episodes of candidemia in 62 children, 48% occurred in the NICU, 31% in the PICU and 21% in pediatric wards. Candida albicans was the most frequent species isolated in NICU infants (53%), and Candida parapsilosis predominated among PICU patients (59%) and pediatric wards (50%). One third of NICU infants had invasive candidiasis (IC), most of them having extremely low birth weight (ELBW) (35%). All isolates were susceptible to the antifungal administered. Over time, the incidence of candidemia decreased in the PICU (from 2.2 to 0.3 episodes/1000 patient-days, OR = 0.6; 95%CI 0.5–0.8), whereas in the NICU and in the wards remained stable. Mortality occurred mostly in NICU patients (26%), predominated in ELBW infants and did not change over time. Conclusions: The higher incidence and mortality of candidemia and IC observed in preterm infants requires a continuous evaluation of practices and diagnostic methods which will allow improving the prognosis of this most vulnerable population. © 2020 Asociación Española de Micología

Keywords

• Antifungal Agents; Candidemia; Candidiasis; Child; Humans; Incidence; Infant; Infant, Newborn; Infant, Premature; Retrospective Studies; Tertiary Care Centers; amphotericin B lipid complex; antifungal agent; caspofungin; cephalosporin derivative; fluconazole; meropenem; micafungin; polypeptide antibiotic agent; vancomycin; voriconazole; antifungal agent; adolescent; age; antifungal activity; antifungal resistance; antifungal susceptibility; antifungal therapy; Article; aspergillosis; brain candidiasis; brain infection; Candida albicans; Candida dubliniensis; Candida glabrata; Candida parapsilosis; Candida tropicalis; candidemia; cardiovascular infection; child; child death; childhood mortality; Clavispora lusitaniae; cohort analysis; controlled study; extremely low birth weight; eye candidiasis; eye infection; female; fungus ball; fungus isolation; heart candidiasis; human; in vitro study; incidence; infant; invasive candidiasis; major clinical study; male; minimum inhibitory concentra