Candidemia in children

Abstract

Seriously ill or immunocompromised children are at increased risk of invasive fungal infections, particularly candidemia. Candida albicans and Candida parapsilosis are the two most frequent causes of candidemia in pediatric patients. Candidemia in children is associated with high morbidity and mortality, increased length of hospital stays, and higher healthcare costs. Early effective antifungal therapy is the key to improved outcomes. Risk factors for candidemia may be used to identify patients suitable for empiric therapy. Such risk factors include prolonged stay in an intensive care unit, immunosuppression, prior bacterial infection, and recent surgery, as well as the use of a central venous catheter, mechanical ventilation, and/or total parenteral nutrition. Recent guidelines from the Infectious Diseases Society of America recommend consideration of fluconazole or an echinocandin for empiric therapy in suitable candidates, with a preference for an echinocandin in patients with moderate-to-severe disease, recent azole exposure, or high risk of Candida glabrata or Candida krusei infection. Fluconazole or an echinocandin is also preferred initial therapy for non-neutropenic candidemia, depending on disease severity and other characteristics. The guidelines recommend treatment with an echinocandin or lipid formulation of amphotericin B for most patients with neutropenic candidemia, although fluconazole is identified as an alternative for less critically ill patients without recent azole exposure. Risk factors for candidemia – and, hence, criteria for prophylaxis – are less well established in older children than in neonates. Further research is needed to better establish criteria for antifungal prophylaxis in children at high risk for candidemia.

Key words::

• Caspofungin
• Central venous catheter
• Echinocandin
• Fluconazole
• Invasive candidiasis
• Mortality
• Prophylaxis
• Voriconazole

Transparency

Declaration of funding

This activity is supported by an educational grant from Merck & Co., Inc.

Declaration of financial/other relationships

T.Z. has disclosed that he has performed contracted research for Merck and has received fees for non-CME services from Cephalon.

Some peer reviewers receive honoraria from CMRO for their review work. Peer reviewer 1 has disclosed that he/she has received research grants from Children’s Cancer Foundation of Baltimore and is on speakers bureaus of Enzon Pharmaceuticals and Sigma Tau Pharmaceuticals. Peer reviewer 2 has no relevant financial relationships to disclose.

Acknowledgment

The authors of this supplement thank Global Education Exchange, LLC, for editorial support.