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Clinical Aspects of Invasive Candidiasis in Paediatric Patients

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Abstract

Candida infections in paediatric patients are an important issue. They are associated with significant mortality, particularly in newborns and those with congenital immunodeficiencies. At present, there is limited knowledge regarding factors associated with an increased risk of developing invasive candidiasis in newborns and those with congenital immunodeficiencies, although there have been a number of studies conducted to characterize these risk factors. These studies have suggested that, in neonates, the most important of these factors is colonization, whereas in paediatric patients with congenital immunodeficiencies, risk factors may differ according to the specific deficiency present.

Regarding treatment of invasive candidiasis in paediatric patients, fluconazole is considered an appropriate choice, although the method for determining treatment strategies for each patient should be the same as that used for such decisions in adult patients.

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References

  1. Castagnola E, Cesaro S, Giacchino M, et al. Fungal infections in children with cancer: a prospective, multicenter surveillance study. Pediatr Infect Dis J 2006; 25: 634–9

    Article  PubMed  Google Scholar 

  2. Castagnola E, Faraci M, Moroni C, et al. Invasive mycoses in children receiving hemopoietic SCT. Bone Marrow Transpl 2008; 41 Suppl.: S107–11

    Article  Google Scholar 

  3. Brook I. Microbiology and management of intra-abdominal infections in children. Pediatr Int 2003; 45: 123–9

    Article  PubMed  Google Scholar 

  4. Chang SL, Shortliffe LD. Pediatric urinary tract infections. Pediatr Clin North Am 2006; 53: 379–400

    Article  PubMed  Google Scholar 

  5. Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002 Aug; 110(2 Pt 1): 285–91

    Article  PubMed  Google Scholar 

  6. Saiman L, Ludington E, Pfaller M, et al. Risk factors for candidemia in neonatal intensive care unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J 2000 Apr; 19(4): 319–24

    CAS  Google Scholar 

  7. Karlowicz MG, Rowen JL, Barnes-Eley ML, et al. The role of birth weight and gestational age in distinguishing extremely low birth weight infants at high risk of developing candidemia from infants at low risk: a multicenter study. Pediatr Res 2002; 51: 301A

    Google Scholar 

  8. Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev 2004 Jul; 17(3): 638–80

    Article  PubMed  Google Scholar 

  9. Benjamin Jr DK, Ross K, McKinney Jr RE, et al. When to suspect fungal infection in neonates: a clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia. Pediatrics 2000 Oct; 106(4): 712–8

    Article  PubMed  Google Scholar 

  10. Rowen JL, Tate JM. Management of neonatal candidiasis. Neonatal Candidiasis Study Group. Pediatr Infect Dis J 1998 Nov; 17(11): 1007–11

    CAS  Google Scholar 

  11. Benjamin Jr DK, Stoll BJ, Fanaroff AA, et al. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics 2006 Jan; 117(1): 84–92

    Article  PubMed  Google Scholar 

  12. Feja KN, Wu F, Roberts K, et al. Risk factors for candidemia in critically ill infants: a matched case-control study. J Pediatr 2005; 147: 156–61

    Article  PubMed  Google Scholar 

  13. Manzoni P, Farina D, Leonessa M, et al. Risk factors for progression to invasive fungal infection in preterm neonates with fungal colonization. Pediatrics 2006 Dec; 118(6): 2359–64

    Article  PubMed  Google Scholar 

  14. Linder N, Levit O, Klinger G, et al. Risk factors associated with candidaemia in the neonatal intensive care unit: a case-control study. J Hosp Infect 2004; 57: 321–4

    Article  PubMed  CAS  Google Scholar 

  15. Makhoul IR, Bental Y, Weisbrod M, et al. Candidal versus bacterial late-onset sepsis in very low birthweight infants in Israel: a national survey. J Hosp Infect 2007; 65: 237–43

    Article  PubMed  Google Scholar 

  16. Clerihew L, Lamagni TL, Brocklehurst P, et al. Candida parapsilosis infection in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2007; 92: F127–9

    Article  PubMed  CAS  Google Scholar 

  17. Johnsson H, Ewald U. The rate of candidaemia in preterm infants born at a gestational age of 23–28 weeks is inversely correlated to gestational age. Acta Paediatr 2004; 93: 954–8

    Article  PubMed  CAS  Google Scholar 

  18. Cotten CM, McDonald S, Stoll B, et al. The association of third-generation cephalosporin use and invasive candidiasis in extremely low birth-weight infants. Pediatrics 2006; 118: 717–22

    Article  PubMed  Google Scholar 

  19. Benjamin DKJ, DeLong ER, Steinbach WJ, et al. Empirical therapy for neonatal candidemia in very low birth weight infants. Pediatrics 2003; 112: 543–7

    Article  PubMed  Google Scholar 

  20. Manzoni P, Stolfi I, Pugni L, et al. A multicenter, randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med 2007; 356: 2483–95

    Article  PubMed  CAS  Google Scholar 

  21. Coates EW, Karlowicz MG, Croitoru DP, et al. Distinctive distribution of pathogens associated with peritonitis in neonates with focal intestinal perforation compared with necrotizing enterocolitis. Pediatrics 2005; 116: e241–6

    Article  PubMed  Google Scholar 

  22. Manzoni P, Farina D, Monetti C, et al. Early-onset neutropenia is a risk factor for Candida colonization in very low-birth-weight neonates. Diagn Microbiol Infect Dis 2007 Jan; 57(1): 77–83

    Article  PubMed  Google Scholar 

  23. Manzoni P, Castagnola E, Mostert M, et al. Hyperglycaemia as a possible marker of invasive fungal infection in preterm neonates. Acta Paediatr 2006; 95: 486–93

    Article  PubMed  Google Scholar 

  24. Farmaki E, Evdoridou J, Pouliou T, et al. Fungal colonization in the neonatal intensive care unit: risk factors, drug susceptibility, and association with invasive fungal infections. Am J Perinatol 2007 Feb; 24(2): 127–35

    Article  PubMed  Google Scholar 

  25. Kicklighter SD, Springer SC, Cox T, et al. Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant. Pediatrics 2001 Feb; 107(2): 293–8

    Article  PubMed  CAS  Google Scholar 

  26. Karlowicz MG. Candidal renal and urinary tract infection in neonates. Semin Perinatol 2003 Oct; 27(5): 393–400

    Article  PubMed  Google Scholar 

  27. Edwards MS. Fungal and protozoal infections. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Fanaroff and Martin’s neonatal-perinatal medicine. Philadelphia (PA): Elsevier Mosby, 2006: 830–40

    Google Scholar 

  28. Mohan P, Eddama O, Weisman LE. Patient isolation measures for infants with Candida colonization or infection for preventing or reducing transmission of Candida in neonatal units. Cochrane Database Syst Rev 2007 Jul; 18 (3): CD006068

  29. Chapman RL. Prevention and treatment of Candida infections in neonates. Semin Perinatol 2007 Feb; 31(1): 39–46

    Article  PubMed  Google Scholar 

  30. Rangel-Frausto MS, Wiblin T, Blumberg HM, et al. National epidemiology of mycoses survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin Infect Dis 1999 Aug; 29(2): 253–8

    Article  PubMed  CAS  Google Scholar 

  31. Fridkin SK, Kaufman D, Edwards JR, et al. Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995–2004. Pediatrics 2006 May; 117(5): 1680–7

    Article  PubMed  Google Scholar 

  32. Manzoni P, Leonessa M, Galletto P, et al. Routine use of fluconazole prophylaxis in a neonatal intensive care unit does not select natively fluconazole-resistant Candida subspecies. Pediatr Infect Dis J 2008 Aug; 27(8): 731–7

    Article  PubMed  Google Scholar 

  33. Wade KC, Wu D, Kaufman DA, et al. Population pharmacokinetics of fluconazole in young infants. Antimicrob Agents Chemother 2008; 52: 4043–9

    Article  PubMed  CAS  Google Scholar 

  34. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009 Mar 1; 48(5): 503–35

    Article  PubMed  CAS  Google Scholar 

  35. Juster-Reicher A, Flidel-Rimon O, Amitay M, et al. Highdose liposomal amphotericin B in the therapy of systemic candidiasis in neonates. Eur J Clin Microbiol Infect Dis 2003 Oct; 22: 603–7

    Article  PubMed  CAS  Google Scholar 

  36. Linder N, Klinger G, Shalit I, et al. Treatment of candidaemia in premature infants: comparison of three amphotericin B preparations. J Antimicrob Chemother 2003 Oct; 52: 663–7

    Article  PubMed  CAS  Google Scholar 

  37. Castagnola E, Franceschi A, Natalizia AR, et al. Combined antifungal therapy in persistent central venous catheter-related candidemia in extremely low birth weight neonates. J Chemother 2009 Apr; 21(2): 234–5

    PubMed  CAS  Google Scholar 

  38. Natarajan G, Lulic-Botica M, Rongkavilit C, et al. Experience with caspofungin in the treatment of persistent fungemia in neonates. J Perinatol 2005 Dec; 25: 770–7

    Article  PubMed  CAS  Google Scholar 

  39. Odio CM, Araya R, Pinto LE, et al. Caspofungin therapy of neonates with invasive candidiasis. Pediatr Infect Dis J 2004; 23: 1093–7

    PubMed  Google Scholar 

  40. Smith PB, Steinbach WJ, Cotten CM, et al. Caspofungin for the treatment of azole resistant candidemia in a premature infant. J Perinatol 2007 Feb; 27: 127–9

    Article  PubMed  CAS  Google Scholar 

  41. Hope WW, Mickiene D, Petraitis V, et al. The pharmacokinetics and pharmacodynamics of micafungin in experimental hematogenous Candida meningoencephalitis: implications for echinocandin therapy in neonates. J infect Dis 2008; 197: 163–71

    Article  PubMed  CAS  Google Scholar 

  42. Pasqualotto AC, de Moraes AB, Zanini RR, et al. Analysis of independent risk factors for death among pediatric patients with candidemia and a central venous catheter in place. Infect Control Hosp Epidemiol 2007 Jul; 28(7): 799–804

    Article  PubMed  Google Scholar 

  43. ImmunoDeficiency Resource. Classification of immunodeficiencies [online]. Available from URL: http://bioinf.uta.fi/xml/idr/classification.xml [Accessed 2009 Jul 20]

  44. Antachopoulos C, Walsh TJ, Roilides E. Fungal infections in primary immunodeficiencies. Eur J Pediatr 2007; 166: 1099–117

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Marie Cheeseman of Wolters Kluwer Pharma Solutions who provided assistance with English language editing. This assistance was funded by Pfizer.

Dr Elio Castagnola has served as an invited speaker at symposia sponsored by Pfizer, Gilead, and Merck Sharp & Dohme. Dr Silvia Buratti has no conflicts of interest to declare.

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Authors and Affiliations

  1. Infectious Diseases Unit, Department of Hematology and Oncology, G. Gaslini Children’s Hospital, Largo G. Gaslini, 5, 16147, Genoa, Italy

    Elio Castagnola

  2. Department of Anesthesia and Intensive Care, G. Gaslini Children’s Hospital, Genoa, Italy

    Silvia Buratti

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  1. Elio Castagnola
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  2. Silvia Buratti
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Correspondence to Elio Castagnola.

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Castagnola, E., Buratti, S. Clinical Aspects of Invasive Candidiasis in Paediatric Patients. Drugs 69 (Suppl 1), 45–50 (2009). https://doi.org/10.2165/11315620-000000000-00000

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