Abstract
Background
The incidence of candidemia in pediatric patients follows the same pattern of increase as in adults, but the rate of increase is greater. Pediatric patients in critical condition, particularly young infants, are especially vulnerable to invasive Candida infections (ICI), partly because of their age and severe underlying disease and partly because of the invasive procedures used.
Discussion
Central venous catheters and arterial lines, parenteral nutrition, mechanical ventilation and extended use of antimicrobials enhance the risk of ICI. C. albicans continues to be the most prevalent isolate. However, an increasing role of non-C. albicans (NAC) spp., some of which are intrinsically or potentially resistant to antifungal agents, has been observed. NAC spp., particularly C. parapsilosis and C. tropicalis, account for almost half of ICI. The increased use of antifungals in immunocompromised patients, mainly prophylactically, is considered the strongest contributory factor to the changes in species distribution, which have subsequently affected the mortality and choice of empirical treatment.
Conclusions
Prompt removal of lines and initiation of antifungal treatment are the milestones of management. Conventional amphotericin B remains a commonly used antifungal agent, but its lipid formulations and fluconazole are also used frequently. Novel antifungal agents such as second-generation triazoles and echinocandins exhibit potential as alternative agents in critically ill children with ICI. Although response rates are still far from satisfactory, improved understanding of risk factors, preventive strategies and new treatment options promise a better future outcome.
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References
Rentz AM, Halpern MT, Bowden R (1998) The impact of candidemia on length of hospital stay, outcome, and overall cost of illness. Clin Infect Dis 27:781–788
Zaoutis TE, Argon J, Chu J, Berlin JA, Walsh TJ, Feudtner C (2005) The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis. Clin Infect Dis 41:1232–1239
Grohskopf LA, Sinkowitz-Cochran RL, Garrett DO, Sohn AH, Levine GL, Siegel JD, Stover BH, Jarvis WR (2002) A national point-prevalence survey of pediatric intensive care unit-acquired infections in the United States. J Pediatr 140:432–438
Chiu NC, Chung YF, Huang FY (1997) Pediatric nosocomial fungal infections. Southeast Asian J Trop Med Public Health 28:191–195
Stamos JK, Rowley AH (1995) Candidemia in a pediatric population. Clin Infect Dis 20:571–575
Abelson JA, Moore T, Bruckner D, Deville J, Nielsen K (2005) Frequency of fungemia in hospitalized pediatric inpatients over 11 years at a tertiary care institution. Pediatrics 116:61–67
Raymond J, Aujard Y (2000) Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group. Infect Control Hosp Epidemiol 21:260–263
Pappas PG, Rex JH, Lee J, Hamill RJ, Larsen RA, Powderly W, Kauffman CA, Hyslop N, Mangino JE, Chapman S, Horowitz HW, Edwards JE, Dismukes WE (2003) A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis 37:634–643
Ridola V, Chachaty E, Raimondo G, Corradini N, Brugieres L, Valteau-Couanet D, Hartmann O (2004) Candida infections in children treated with conventional chemotherapy for solid tumors (transplant recipients excluded): the Institut Gustave Roussy Pediatrics Department experience. Pediatr Blood Cancer 42:332–337
Krcmery V, Laho L, Huttova M, Ondrusova A, Kralinsky K, Pevalova L, Dluholucky S, Pisarcikova M, Hanzen J, Filka J, Sejnova D, Liskova A, Purgelova A, Szovenyova Z, Koren P (2002) Aetiology, antifungal susceptibility, risk factors and outcome in 201 fungaemic children: data from a 12-year prospective national study from Slovakia. J Med Microbiol 51:110–116
MacDonald L, Baker C, Chenoweth C (1998) Risk factors for candidemia in a children's hospital. Clin Infect Dis 26:642–645
Rangel-Frausto MS, Wiblin T, Blumberg HM, Saiman L, Patterson J, Rinaldi M, Pfaller M, Edwards JE Jr, Jarvis W, Dawson J, Wenzel RP (1999) 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 29:253–258
Singhi SC, Reddy TC, Chakrabarti A (2004) Candidemia in a pediatric intensive care unit. Pediatr Crit Care Med 5:369–374
Pfaller MA, Diekema DJ, Jones RN, Messer SA, Hollis RJ (2002) Trends in antifungal susceptibility of Candida spp. isolated from pediatric and adult patients with bloodstream infections: SENTRY Antimicrobial Surveillance Program, 1997 to 2000. J Clin Microbiol 40:852–856
Zaoutis TE, Greves HM, Lautenbach E, Bilker WB, Coffin SE (2004) Risk factors for disseminated candidiasis in children with candidemia. Pediatr Infect Dis J 23:635–641
Trick WE, Fridkin SK, Edwards JR, Hajjeh RA, Gaynes RP (2002) Secular trend of hospital-acquired candidemia among intensive care unit patients in the United States during 1989–1999. Clin Infect Dis 35:627–630
Almirante B, Rodriguez D, Park BJ, Cuenca-Estrella M, Planes AM, Almela M, Mensa J, Sanchez F, Ayats J, Gimenez M, Saballs P, Fridkin SK, Morgan J, Rodriguez-Tudela JL, Warnock DW, Pahissa A (2005) Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol 43:1829–1835
Wisplinghoff H, Seifert H, Tallent SM, Bischoff T, Wenzel RP, Edmond MB (2003) Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features and susceptibilities. Pediatr Infect Dis J 22:686–691
Levy I, Rubin LG, Vasishtha S, Tucci V, Sood SK (1998) Emergence of Candida parapsilosis as the predominant species causing candidemia in children. Clin Infect Dis 26:1086–1088
San Miguel LG, Cobo J, Otheo E, Sanchez-Sousa A, Abraira V, Moreno S (2005) Secular trends of candidemia in a large tertiary-care hospital from 1988 to 2000: emergence of Candida parapsilosis. Infect Control Hosp Epidemiol 26:548–552
Krcmery V, Barnes AJ (2002) Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance. J Hosp Infect 50:243–260
Waggoner-Fountain LA, Walker MW, Hollis RJ, Pfaller MA, Ferguson JE 2nd, Wenzel RP, Donowitz LG (1996) Vertical and horizontal transmission of unique Candida species to premature newborns. Clin Infect Dis 22:803–808
Mokaddas EM, Ramadan SA, Abo el Maaty SH, Sanyal SC (2000) Candidemia in pediatric surgery patients. J Chemother 12:332–338
Mullen CA, Abd El-Baki H, Samir H, Tarrand JJ, Rolston KV (2003) Non-albicans Candida is the most common cause of candidemia in pediatric cancer patients. Support Care Cancer 11:321–325
Weems JJ Jr (1992) Candida parapsilosis: epidemiology, pathogenicity, clinical manifestations, and antimicrobial susceptibility. Clin Infect Dis 14:756–766
Nguyen MH, Peacock JE Jr, Morris AJ, Tanner DC, Nguyen ML, Snydman DR, Wagener MM, Rinaldi MG, Yu VL (1996) The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med 100:617–623
Rodriguez-Nunez A (2001) Incidence and mortality of proven invasive Candida infections in pediatric intensive care patients. Infect Control Hosp Epidemiol 22:477–478
Benjamin DK Jr, Miller WC, Bayliff S, Martel L, Alexander KA, Martin PL (2002) Infections diagnosed in the first year after pediatric stem cell transplantation. Pediatr Infect Dis J 21:227–234
Lehrnbecher T, Varwig D, Kaiser J, Reinhardt D, Klingebiel T, Creutzig U (2004) Infectious complications in pediatric acute myeloid leukemia: analysis of the prospective multi-institutional clinical trial AML-BFM 93. Leukemia 18:72–77
el-Mahallawy HA, Attia I, Ali-el-Din NH, Salem AE, Abo-el-Naga S (2002) A prospective study on fungal infection in children with cancer. J Med Microbiol 51:601–605
Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751
Gladdy RA, Richardson SE, Davies HD, Superina RA (1999) Candida infection in pediatric liver transplant recipients. Liver Transpl Surg 5:16–24
al Soub H, Estinoso W (1997) Hospital-acquired candidaemia: experience from a developing country. J Hosp Infect 35:141–147
Hiranandani M, Singhi SC, Kaur I, Chakrabarti A (1995) Disseminated nosocomial candidiasis in a pediatric intensive care unit. Indian Pediatr 32:1160–1166
Montane BS, Mazza I, Abitbol C, Zilleruelo G, Strauss J, Coakley S, Diaz R (1998) Fungal peritonitis in pediatric patients. Adv Perit Dial 14:251–254
Rowen JL, Rench MA, Kozinetz CA, Adams JM Jr, Baker CJ (1994) Endotracheal colonization with Candida enhances risk of systemic candidiasis in very low birth weight neonates. J Pediatr 124:789–794
Sheridan RL, Weber JM, Budkevich LG, Tompkins RG (1995) Candidemia in the pediatric patient with burns. J Burn Care Rehabil 16:440–443
Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F, Denning DW, Donnelly JP, Edwards JE, Erjavec Z, Fiere D, Lortholary O, Maertens J, Meis JF, Patterson TF, Ritter J, Selleslag D, Shah PM, Stevens DA, Walsh TJ (2002) Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 34:7–14
Eggimann P, Pittet D (2001) [Candidiasis among non-neutropenic patients: from colonization to infection]. Ann Fr Anesth Reanim 20:382–388
Rex JH, Walsh TJ, Sobel JD, Filler SG, Pappas PG, Dismukes WE, Edwards JE (2000) Practice guidelines for the treatment of candidiasis. Infect Dis Soc Am. Clin Infect Dis 30:662–678
Sobel JD, Kauffman CA, McKinsey D, Zervos M, Vazquez JA, Karchmer AW, Lee J, Thomas C, Panzer H, Dismukes WE (2000) Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 30:19–24
Chakrabarti A, Reddy TC, Singhi S (1997) Does candiduria predict candidaemia? Indian J Med Res 106:513–516
Azoulay E, Cohen Y, Zahar JR, Garrouste-Orgeas M, Adrie C, Moine P, de Lassence A, Timsit JF (2004) Practices in non-neutropenic ICU patients with Candida-positive airway specimens. Intensive Care Med 30:1384–1389
Mermel LA, Farr BM, Sherertz RJ, Raad II, O'Grady N, Harris JS, Craven DE (2001) Guidelines for the management of intravascular catheter-related infections. J Intraven Nurs 24:180–205
Nucci M, Anaissie E (2002) Should vascular catheters be removed from all patients with candidemia? An evidence-based review. Clin Infect Dis 34:591–599
Goldman RD, Koren G (2004) Amphotericin B nephrotoxicity in children. J Pediatr Hematol Oncol 26:421–426
Pappas PG, Rex JH, Sobel JD, Filler SG, Dismukes WE, Walsh TJ, Edwards JE (2004) Guidelines for treatment of candidiasis. Clin Infect Dis 38:161–189
Pannaraj PS, Walsh TJ, Baker CJ (2005) Advances in antifungal therapy. Pediatr Infect Dis J 24:921–922
Zaoutis TE, Benjamin DK, Steinbach WJ (2005) Antifungal treatment in pediatric patients. Drug Resist Updat 8:235–245
Antachopoulos C, Walsh TJ (2005) New agents for invasive mycoses in children. Curr Opin Pediatr 17:78–87
Fernandez M, Moylett EH, Noyola DE, Baker CJ (2000) Candidal meningitis in neonates: a 10-year review. Clin Infect Dis 31:458–463
Wiley JM, Seibel NL, Walsh TJ (2005) Efficacy and safety of amphotericin B lipid complex in 548 children and adolescents with invasive fungal infections. Pediatr Infect Dis J 24:167–174
Herbrecht R, Auvrignon A, Andres E, Guillemain R, Suc A, Eyer D, Pailler C, Letscher-Bru V, Leverger G, Schaison G (2001) Efficacy of amphotericin B lipid complex in the treatment of invasive fungal infections in immunosuppressed paediatric patients. Eur J Clin Microbiol Infect Dis 20:77–82
Schwarze R, Penk A, Pittrow L (2000) Treatment of candidal infections with fluconazole in neonates and infants. Eur J Med Res 5:203–208
Saxen H, Hoppu K, Pohjavuori M (1993) Pharmacokinetics of fluconazole in very low birth weight infants during the first two weeks of life. Clin Pharmacol Ther 54:269–277
Mondal RK, Singhi SC, Chakrabarti A, et al. (2004) Randomized comparison between fluconazole and itraconazole for the treatment of candidemia in a pediatric intensive care unit: a preliminary study. Pediatr Crit Care Med 5:561–565
de Repentigny L, Ratelle J, Leclerc JM, Cornu G, Sokal EM, Jacqmin P, De Beule K (1998) Repeated-dose pharmacokinetics of an oral solution of itraconazole in infants and children. Antimicrob Agents Chemother 42:404–408
Walsh TJ, Lutsar I, Driscoll T, Dupont B, Roden M, Ghahramani P, Hodges M, Groll AH, Perfect JR (2002) Voriconazole in the treatment of aspergillosis, scedosporiosis and other invasive fungal infections in children. Pediatr Infect Dis J 21:240–248
Seibel NL, Schwartz C, Arrieta A, Flynn P, Shad A, Albano E, Keirns J, Lau WM, Facklam DP, Buell DN, Walsh TJ (2005) Safety, tolerability, and pharmacokinetics of micafungin (FK463) in febrile neutropenic pediatric patients. Antimicrob Agents Chemother 49:3317–3324
Franklin JA, McCormick J, Flynn PM (2003) Retrospective study of the safety of caspofungin in immunocompromised pediatric patients. Pediatr Infect Dis J 22:747–749
Tollemar J, Klingspor L, Ringden O (2001) Liposomal amphotericin B (AmBisome) for fungal infections in immunocompromised adults and children. Clin Microbiol Infect 7(Suppl 2):68–79
Sandler ES, Mustafa MM, Tkaczewski I, Graham ML, Morrison VA, Green M, Trigg M, Abboud M, Aquino VM, Gurwith M, Pietrelli L (2000) Use of amphotericin B colloidal dispersion in children. J Pediatr Hematol Oncol 22:242–246
Knoppert DC, Salama HE, Lee DS (2001) Eradication of severe neonatal systemic candidiasis with amphotericin B lipid complex. Ann Pharmacother 35:1032–1036
Vermes A, Guchelaar HJ, Dankert J (2000) Flucytosine: a review of its pharmacology, clinical indications, pharmacokinetics, toxicity and drug interactions. J Antimicrob Chemother 46:171–179
Girmenia C, Venditti M, Martino P (2003) Fluconazole in combination with flucytosine in the treatment of fluconazole-resistant Candida infections. Diagn Microbiol Infect Dis 46:227–231
Jeu L, Piacenti FJ, Lyakhovetskiy AG, Fung HB (2003) Voriconazole. Clin Ther 25:1321–1381
Walsh TJ, Karlsson MO, Driscoll T, Arguedas AG, Adamson P, Saez-Llorens X, Vora AJ, Arrieta AC, Blumer J, Lutsar I, Milligan P, Wood N (2004) Pharmacokinetics and safety of intravenous voriconazole in children after single- or multiple-dose administration. Antimicrob Agents Chemother 48:2166–2172
Segal BH, Barnhart LA, Anderson VL, Walsh TJ, Malech HL, Holland SM (2005) Posaconazole as salvage therapy in patients with chronic granulomatous disease and invasive filamentous fungal infection. Clin Infect Dis 40:1684–1688
Gauthier GM, Nork TM, Prince R, Andes D (2005) Subtherapeutic ocular penetration of caspofungin and associated treatment failure in Candida albicans endophthalmitis. Clin Infect Dis 41:e27–e28
Walsh TJ, Adamson PC, Seibel NL, Flynn PM, Neely MN, Schwartz C, Shad A, Kaplan SL, Roden MM, Stone JA, Miller A, Bradshaw SK, Li SX, Sable CA, Kartsonis NA (2005) Pharmacokinetics, safety, and tolerability of caspofungin in children and adolescents. Antimicrob Agents Chemother 49:4536–4545
Groll AH, Attarbaschi A, Schuster FR, Herzog N, Grigull L, Dworzak MN, Beutel K, Laws HJ, Lehrnbecher T (2006) Treatment with caspofungin in immunocompromised paediatric patients: a multicentre survey. J Antimicrob Chemother 57:527–535
Walsh TJ, Teppler H, Donowitz GR, Maertens JA, Baden LR, Dmoszynska A, Cornely OA, Bourque MR, Lupinacci RJ, Sable CA, dePauw BE (2004) Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med 351:1391–1402
van Burik JA, Ratanatharathorn V, Stepan DE, Miller CB, Lipton JH, Vesole DH, Bunin N, Wall DA, Hiemenz JW, Satoi Y, Lee JM, Walsh TJ (2004) Micafungin versus fluconazole for prophylaxis against invasive fungal infections during neutropenia in patients undergoing hematopoietic stem cell transplantation. Clin Infect Dis 39:1407–1416
Ostrosky-Zeichner L, Kontoyiannis D, Raffalli J, Mullane KM, Vazquez J, Anaissie EJ, Lipton J, Jacobs P, van Rensburg JH, Rex JH, Lau W, Facklam D, Buell DN (2005) International, open-label, noncomparative, clinical trial of micafungin alone and in combination for treatment of newly diagnosed and refractory candidemia. Eur J Clin Microbiol Infect Dis 24:654–661
Benjamin DK Jr, Driscoll T, Seibel NL, Gonzalez CE, Roden MM, Kilaru R, Clark K, Dowell JA, Schranz J, Walsh TJ (2006) Safety and pharmacokinetics of intravenous anidulafungin in children with neutropenia at high risk for invasive fungal infections. Antimicrob Agents Chemother 50:632–638
Kovacicova G, Hanzen J, Pisarcikova M, Sejnova D, Horn J, Babela R, Svetlansky I, Lovaszova M, Gogova M, Krcmery V (2001) Nosocomial fungemia due to amphotericin B-resistant Candida spp. in three pediatric patients after previous neurosurgery for brain tumors. J Infect Chemother 7:45–48
Chen TC, Chen YH, Tsai JJ, Peng CF, Lu PL, Chang K, Hsieh HC, Chen TP (2005) Epidemiologic analysis and antifungal susceptibility of Candida blood isolates in southern Taiwan. J Microbiol Immunol Infect 38:200–210
Zaoutis TE, Foraker E, McGowan KL, Mortensen J, Campos J, Walsh TJ, Klein JD (2005) Antifungal susceptibility of Candida spp. isolated from pediatric patients: a survey of 4 children's hospitals. Diagn Microbiol Infect Dis 52:295–298
Pfaller MA, Messer SA, Boyken L, Hollis RJ, Rice C, Tendolkar S, Diekema DJ (2004) In vitro activities of voriconazole, posaconazole, and fluconazole against 4:169 clinical isolates of Candida spp. and Cryptococcus neoformans collected during 2001 and 2002 in the ARTEMIS global antifungal surveillance program. Diagn Microbiol Infect Dis 48:201–205
Pfaller MA, Messer SA, Boyken L, Rice C, Tendolkar S, Hollis RJ, Diekema DJ (2004) Cross-resistance between fluconazole and ravuconazole and the use of fluconazole as a surrogate marker to predict susceptibility and resistance to ravuconazole among 12:796 clinical isolates of Candida spp. J Clin Microbiol 42:3137–3141
Muller FM, Weig M, Peter J, Walsh TJ (2000) Azole cross-resistance to ketoconazole, fluconazole, itraconazole and voriconazole in clinical Candida albicans isolates from HIV-infected children with oropharyngeal candidosis. J Antimicrob Chemother 46:338–340
Espinel-Ingroff A (1998) Comparison of in vitro activities of the new triazole SCH56592 and the echinocandins MK-0991 (L-743:872) and LY303366 against opportunistic filamentous and dimorphic fungi and yeasts. J Clin Microbiol 36:2950–2956
Ostrosky-Zeichner L, Rex JH, Pappas PG, Hamill RJ, Larsen RA, Horowitz HW, Powderly WG, Hyslop N, Kauffman CA, Cleary J, Mangino JE, Lee J (2003) Antifungal susceptibility survey of 2:000 bloodstream Candida isolates in the United States. Antimicrob Agents Chemother 47:3149–3154
Park S, Kelly R, Kahn JN, Robles J, Hsu MJ, Register E, Li W, Vyas V, Fan H, Abruzzo G, Flattery A, Gill C, Chrebet G, Parent SA, Kurtz M, Teppler H, Douglas CM, Perlin DS (2005) Specific substitutions in the echinocandin target Fks1p account for reduced susceptibility of rare laboratory and clinical Candida spp. isolates. Antimicrob Agents Chemother 49:3264–3273
Hernandez S, Lopez-Ribot JL, Najvar LK, McCarthy DI, Bocanegra R, Graybill JR (2004) Caspofungin resistance in Candida albicans: correlating clinical outcome with laboratory susceptibility testing of three isogenic isolates serially obtained from a patient with progressive Candida esophagitis. Antimicrob Agents Chemother 48:1382–1383
Rex JH, Sobel JD (2001) Prophylactic antifungal therapy in the intensive care unit. Clin Infect Dis 32:1191–1200
Vardakas KZ, Samonis G, Michalopoulos A, Soteriades ES, Falagas ME (2006) Antifungal prophylaxis with azoles in high-risk, surgical intensive care unit patients: a meta-analysis of randomized, placebo-controlled trials. Crit Care Med 34:1216–1224
Cruciani M, de Lalla F, Mengoli C (2005) Prophylaxis of Candida infections in adult trauma and surgical intensive care patients: a systematic review and meta-analysis. Intensive Care Med 31:1479–1487
Shorr AF, Chung K, Jackson WL, Waterman PE, Kollef MH (2005) Fluconazole prophylaxis in critically ill surgical patients: a meta-analysis. Crit Care Med 33:1928–1935
Playford EG, Webster AC, Sorrell TC, Craig JC (2006) Antifungal agents for preventing fungal infections in non-neutropenic critically ill and surgical patients: systematic review and meta-analysis of randomized clinical trials. J Antimicrob Chemother 57:628–638
Manzoni P, Arisio R, Mostert M, Leonessa M, Farina D, Latino MA, Gomirato G (2006) Prophylactic fluconazole is effective in preventing fungal colonization and fungal systemic infections in preterm neonates: a single-center, 6-year, retrospective cohort study. Pediatrics 117:e22–e32
Pittet D, Li N, Woolson RF, Wenzel RP (1997) Microbiological factors influencing the outcome of nosocomial bloodstream infections: a 6-year validated, population-based model. Clin Infect Dis 24:1068–1078
Pacheco-Rios A, Avila-Figueroa C, Nobigrot-Kleinman D, Santos JI (1997) Mortality associated with systemic candidiasis in children. Arch Med Res 28:229–232
Zaoutis TE, Coffin SE, Chu JH, Heydon K, Zhao H, Greves HM, Walsh TJ (2005) Risk factors for mortality in children with candidemia. Pediatr Infect Dis J 24:736–739
Rosen GP, Nielsen K, Glenn S, Abelson J, Deville J, Moore TB (2005) Invasive fungal infections in pediatric oncology patients: 11-year experience at a single institution. J Pediatr Hematol Oncol 27:135–140
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An erratum to this article can be found at http://dx.doi.org/10.1007/s00134-007-0751-7
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Filioti, J., Spiroglou, K. & Roilides, E. Invasive candidiasis in pediatric intensive care patients: epidemiology, risk factors, management, and outcome. Intensive Care Med 33, 1272–1283 (2007). https://doi.org/10.1007/s00134-007-0672-5
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DOI: https://doi.org/10.1007/s00134-007-0672-5