Etiology and Outcome of Candidemia in Neonates and Children in Europe: An 11-year Multinational Retrospective Study

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  • Adilia Warris
  • Zoi Dorothea Pana
  • Andrea Oletto
  • Rebecca Lundin
  • Elio Castagnola
  • Thomas Lehrnbecher
  • Andreas H. Groll
  • Emmanuel Roilides
  • Cecilie T. Andersen
  • Valentina Arsic Arsenijevic
  • Sonia Bianchini
  • Ulrich Von Both
  • Martin Chmelnik
  • Tiziana Controzzi
  • Marieke Emonts
  • Susanna Esposito
  • Laura Ferreras-Antolin
  • Stefanie Henriet
  • Elias Iosifidis
  • Adam Irwin
  • John Kopsidas
  • Katrien Lagrou
  • Hermione Lyall
  • Angela Manzanares Casteleiro
  • Alessio Mesini
  • Peter Olbrich
  • Stephane Paulus
  • Karen Rokkedal Lausch
  • Pere Soler-Palacin
  • Nikos Spyridis
  • Volker Strenger
  • Martha Theodoraki
  • Tom Wolfs

Background: Data on Candida bloodstream infections in pediatric patients in Europe are limited. We performed a retrospective multicenter European study of the epidemiology and outcome of neonatal and pediatric candidemia. Material and Methods: All first positive blood cultures from patients ≤ 18 years of age with candidemia were registered. Patients' demographic and clinical characteristics and causative Candida species were collected and analyzed. Regression analysis was used to identify factors independently associated with mortality. Results: One thousand three hundred ninety-five episodes of candidemia (57.8% male) were reported from 23 hospitals in 10 European countries. Of the 1395 episodes, 36.4% occurred in neonates (≤ 44 weeks postmenstrual age), 13.8% in infants (> 44 weeks postmenstrual age to 1 year) and 49.8% in children and adolescents. Candida albicans (52.5%) and Candida parapsilosis (28%) were the predominant species. A higher proportion of candidemia caused by C. albicans was observed among neonatal patients (60.2%) with highest rates of C. parapsilosis seen among infants (42%). Children admitted to hematology-oncology wards presented the highest rates of non-albicans Candida species. Candidemia because of C. albicans was more frequent than non-albicans Candida in Northern versus Southern Europe (odds ratio, 2.3; 95% confidence interval, 1.8-2.9; P < 0.001). The all-cause mortality at 30 days was 14.4%. All-cause mortality was higher among patients admitted to the neonatal or pediatric intensive care units than other wards. Over time, no significant changes in species distribution were observed. Conclusions: This first multicenter European study shows unique characteristics of the epidemiology of pediatric candidemia. The insights obtained from this study will be useful to guide clinical management and antifungal stewardship.

OriginalsprogEngelsk
TidsskriftPediatric Infectious Disease Journal
Vol/bind39
Udgave nummer2
Sider (fra-til)114-120
Antal sider7
ISSN0891-3668
DOI
StatusUdgivet - 2020

ID: 251584681