A 14-Year Cohort of Candidemia in the Pediatric Population in a Tertiary Center in Jerusalem: Clinical Characteristics, Antifungal Susceptibility, and Risk Factors for Mortality
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Data Collection
- (1)
- blood culture yielding Candida spp.;
- (2)
- patient aged 0–18 years;
- (3)
- clinical picture consistent with infection, such as fever, deterioration in patient condition.
2.3. Microbiology Data
2.4. Definitions
2.5. Statistical Analysis
3. Results
3.1. Clinical Characteristics (Table 1)
3.2. Microbiological Characteristics (Table 2)
3.3. Treatment and Outcome (Table 1 and Table 3)
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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Total Episodes (n, %) | Episodes with 30 Days Survival (n, %) | Episodes with 30 Days Mortality (n, %) | p Value | |
---|---|---|---|---|
Total patients (n) | 127 | 102 (80.3) | 25 (19.7) | |
Female: Male | 1.04 | 1.04 | 1.08 | 0.92 |
Age at first episode in years (median, IQR) | 2.45 (0.36, 5.65) | 2.5 (0.4, 5.3) | 1.2 (0.05, 6.3) | 0.28 |
Underlying diseases | ||||
Immune-compromised patients | 66 (51.9) | 53 (52) | 13 (52) | 0.99 |
Allogeneic HCT | 21 (16.5) | 16 (15.7) | 5 (20) | |
Autologous HCT | 6 (4.7) | 5 (4.9) | 1 (4) | |
Hematological malignancy | 16 (12.6) | 15 (14.7) | 1 (4) | |
Solid tumors | 14 (11) | 13 (12.7) | 1 (4) | |
Others | 9 (7.1) | 4 (3.9) | 5 (20) | |
Prematurity | 22 (17.3) | 16 (15.7) | 6 (24) | 0.37 |
Other underlying disease | 65 (51.2) | 56 (54.9) | 9 (36) | 0.09 |
Abdominal surgery | 18 (14.2) | 11 (10.8) | 7 (28) | 0.049 |
Central venous catheter | 104 (81.9) | 82 (80.4) | 22 (88) | 0.56 |
Total parenteral nutrition | 71 (55.9) | 52 (51) | 19 (76) | 0.024 |
Number of hospitalization days in the last 3 months, median (IQR) (n = 124) | 26.5 (10, 51) | 27 (10, 50) | 25 (8, 69.5) | 0.92 |
Candidemia developed while in PICU | 53 (41.7) | 33 (32.4) | 20 (80) | <0.001 |
Time from hospital admission to candidemia (first positive culture), days, median (IQR) | 12 (5, 28) | 11 (2, 26.5) | 20 (8, 57.5) | 0.017 |
Previous antifungal therapy | 26 (20.5) | 16 (15.7) | 10 (40) | 0.007 |
Azole | 25 (19.7) | 15 (14.7) | 10 (40) | 0.009 |
Amphotericin B | 1 (0.8%) | 1 (1) | 0 (0) | 1 |
Echinocandin | 4 (3.1%) | 3 (2.9) | 1 (4) | 1 |
Systemic antibiotics within a month preceding candidemia onset | 114 (89.8) | 90 (88.2) | 24 (96) | 0.46 |
Beta-lactam | 105 (82.7) | 83 (81.4) | 22 (88) | 0.53 |
Penicillins | 59 (46.5) | 46 (45.1) | 13 (52) | 0.53 |
Cephalosporins | 45 (35.4) | 40 (39.2) | 5 (20) | 0.072 |
Carbapenem | 67 (52.8) | 47 (46.1) | 20 (80) | 0.002 |
Aminoglycosides | 38 (29.9) | 28 (27.5) | 10 (40) | 0.22 |
Vancomycin | 51 (40.2) | 36 (35.3) | 15 (60) | 0.024 |
Colistin | 7 (5.5) | 5 (4.9) | 2 (8) | 0.6 |
Fluoroquinolones | 21 (16.5) | 17 (16.7) | 4 (16) | 1 |
Absolute neutrophil count 109/L median (IQR) | 4.5 (0.66, 10.5) | 4.45 (0.5, 9.8) | 6 (0.96, 15.7) | 0.36 |
Severe neutropenia at the time of candidemia | 30 (23.6) | 25 (24.5) | 5 (20) | 0.63 |
Microbiological data | ||||
Candida non-albicans | 71 (55.9) | 58 (56.8) | 13 (52) | 0.66 |
Poly-candidemia | 4 (3.1) | 3 (2.9) | 1 (4) | 1 |
Shock | 27 (21.3) | 13 (12.7) | 14 (56) | 0 |
Chronic disseminated candidiasis | 15 (11.8) | 14 (13.7) | 1 (4) | 0.3 |
CVC removal | 46/104 (36.8) | 39/82 (47.5) | 7/22 (31.8) | 0.15 |
Fluconazole resistance | 10/121 (8.2) | 8/98 (8.1) | 2/23 (8.6) | 1 |
Inappropriate empirical antifungal treatment | 9 (7.1) | 6 (5.9) | 3 (12) | 0.38 |
Duration of candidemia (days), median (IQR) | 1 (0, 5) | 0 (0, 4) | 3 (0.5, 7.5) | 0.05 |
Candida spp. | Fluconazole n/N (%) | Voriconazole n/N (%) | Caspofungin n/N (%) | Amphotericin B n/N (%) |
---|---|---|---|---|
Candida albicans | 1/57 (1.7) | 0/27 (0) | 0/26 (0) | 0/25 (0) |
Candida parapsilosis | 1/22 (4.5) | 0/22 | 0/22 (0) | 1/22 (4.5) |
Candida tropicalis | 1/17 (5.8) | 1/17 (5.8) | 0/17 (0) | 0/17 (0) |
Nakaseomyces glabrata | 1/11 (10) | 1/10 (10) | 2/5 (40) | 0/11 (0) |
Candida krusei | 6/6 (100) | 0/6 (0) | 4/6 (66.6) | 0/6 (0) |
Others a | 6/19 (31.5) | 1/7 (14.2) | 0/4 (0) | NA a |
Overall | 16/132 (12.1) | 3/89 (3.3) | 6/80 (7.5) | 1/80 (1.2) |
Factors | Adjusted OR | 95% CI | p Value |
---|---|---|---|
Candidemia developed while in PICU | 7.07 | 1.89–26.39 | 0.004 |
Azole treatment in last month | 4.43 | 0.98–19.98 | 0.05 |
Carbapenem in last month | 4.77 | 1.27–17.79 | 0.02 |
Presence of shock | 4.52 | 1.29–15.74 | 0.018 |
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Korem, M.; Taragin, A.; Dror, D.; Temper, V.; Averbuch, D. A 14-Year Cohort of Candidemia in the Pediatric Population in a Tertiary Center in Jerusalem: Clinical Characteristics, Antifungal Susceptibility, and Risk Factors for Mortality. J. Fungi 2023, 9, 1171. https://doi.org/10.3390/jof9121171
Korem M, Taragin A, Dror D, Temper V, Averbuch D. A 14-Year Cohort of Candidemia in the Pediatric Population in a Tertiary Center in Jerusalem: Clinical Characteristics, Antifungal Susceptibility, and Risk Factors for Mortality. Journal of Fungi. 2023; 9(12):1171. https://doi.org/10.3390/jof9121171
Chicago/Turabian StyleKorem, Maya, Asher Taragin, Danna Dror, Violeta Temper, and Dina Averbuch. 2023. "A 14-Year Cohort of Candidemia in the Pediatric Population in a Tertiary Center in Jerusalem: Clinical Characteristics, Antifungal Susceptibility, and Risk Factors for Mortality" Journal of Fungi 9, no. 12: 1171. https://doi.org/10.3390/jof9121171