Recent changes in candidemia trends in a tertiary hospital (2011–2018)

• Published in: Revista iberoamericana de micología 2020-07, Vol.37 (3-4), p.87-93
• Main Authors: Piqueras, Ana I., Rubio, Thomas, Lopez-Medina, Eva M., Gimeno, Ana, Modesto, Vicent, Cantón, Emilia, Pemán, Javier
• Format: Article
• Language: English
• Subjects: Agentes antifúngicos; Antifungal agents; Candidemia; Candidiasis invasora; Epidemiology; Epidemiología; Invasive candidiasis
• ISSN: 1130-1406
• DOI: 10.1016/j.riam.2020.09.005

The epidemiology of candidemia has changed over the last decades and varies widely among geographic areas. We examined in children (aged 0–14) with candidemia the trends in the incidence rate of this infection, as well as the clinical characteristics of the patients, in order to optimize the prognosis and the control measures of this serious disease. A retrospective cohort study of candidemia in the period 2011–2018 in the neonatal intensive care unit (NICU), pediatric ICU (PICU) and pediatric wards of a tertiary hospital, was conducted. The clinical course, Candida species isolated, antifungal susceptibility, outcome and incidence rates were analyzed and compared. We diagnosed 68 episodes of candidemia in 62 children, 48% occurred in the NICU, 31% in the PICU and 21% in pediatric wards. Candida albicans was the most frequent species isolated in NICU infants (53%), and Candida parapsilosis predominated among PICU patients (59%) and pediatric wards (50%). One third of NICU infants had invasive candidiasis (IC), most of them having extremely low birth weight (ELBW) (35%). All isolates were susceptible to the antifungal administered. Over time, the incidence of candidemia decreased in the PICU (from 2.2 to 0.3 episodes/1000 patient-days, OR=0.6; 95%CI 0.5–0.8), whereas in the NICU and in the wards remained stable. Mortality occurred mostly in NICU patients (26%), predominated in ELBW infants and did not change over time. The higher incidence and mortality of candidemia and IC observed in preterm infants requires a continuous evaluation of practices and diagnostic methods which will allow improving the prognosis of this most vulnerable population. La epidemiología de la candidemia varía con el tiempo y entre las áreas geográficas. Se ha estudiado en niños (0-14 años) con candidemia la evolución de la tasa de incidencia y las características clínicas de los pacientes para optimizar el pronóstico y las medidas de control de esta grave enfermedad. Se llevó a cabo un estudio de cohorte retrospectivo de los casos de candidemia en la unidad de cuidados intensivos neonatales (UCIN), UCI pediátrica (UCIP) y salas pediátricas de un hospital terciario, entre los años 2011 y 2018. Se compara el curso clínico, las especies de Candida, la sensibilidad antifúngica y las tasas de incidencia. Se diagnosticaron 68 episodios de candidemia en 62 niños; el 48% de ellos tuvieron lugar en UCIN, el 31% en UCIP y el 21% en salas pediátricas. Candida albicans fue la especie más frecue