Epidemiology, risk factors and therapy of candidemia in pediatric hematological patients

Chiara Cugno, Simone Cesaro

Research output: Contribution to journalArticle

Abstract

Invasive fungal infections (IFI) are an important cause of morbidity, increased hospitalization and healthcare costs in critically ill or immunocompromised children. The mortality is comprised between 5 and 20%. In the last 2 decades, the epidemiology of candidemia has changed with an increase of episodes caused by non-Candida albicans species. Central venous catheter, diagnosis of malignancy, and receipt of either vancomycin or antimicrobials with activity against anaerobic organisms for > 3 days have been associated with the development of candidemia in the pediatric intensive care unit (PICU). Additional risk factors found in hematological patients were the diagnosis of aplastic anemia, performing an unrelated bone marrow or cord blood transplant, the occurrence of a graft versus host disease and the use of steroids. Early antifungal treatment is recommended to reduce mortality. In neutropenic patients, liposomal amphotericin B, an echinocandin (caspofungin, micafungin), and voriconazole are considered the best option especially for C. glabrata and C. krusei. Fluconazole remains a valid option for infection by Candida albicans in patients not exposed to fluconazole prophylaxis. Amphotericn B deoxycholate is generally not recommended because of its nephrotoxicity.

Original languageEnglish
Article numbere9
JournalPediatric Reports
Volume4
Issue number1
DOIs
Publication statusPublished - 2012

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Keywords

  • Candida spp. Sepsis
  • Candidemia

ASJC Scopus subject areas

  • Pediatrics

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