Candidemia in a Pediatric Population

• Published in: Clinical infectious diseases 1995-03, Vol.20 (3), p.571-575
• Main Authors: Stamos, Julie Kim, Rowley, Anne H.
• Format: Article
• Language: English
• Subjects: Adolescent; Age Distribution; Amphotericin B - therapeutic use; Antifungals; Biological and medical sciences; Blood; Candida; Candidemia; Candidiasis - drug therapy; Candidiasis - microbiology; Candidiasis - mortality; Catheters; Child; Child health services; Child, Preschool; Children; Clinical Articles; Diseases; Drug Therapy, Combination; Female; Flucytosine - therapeutic use; Fungemia - drug therapy; Fungemia - microbiology; Fungemia - mortality; Human mycoses; Humans; Infant; Infant, Newborn; Infectious diseases; Male; Medical sciences; Miscellaneous mycoses; Mortality; Mycoses; Necrotizing enterocolitis; Pediatrics; Treatment Outcome
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clinids/20.3.571

Candidemia results in a mortality of >50% among adults, but data on children with candidemia are limited. We reviewed 70 episodes of pediatric candidemia that occurred between January 1988 and October 1992. Of these episodes, 53% were caused by Candida albicans, 24% were caused by Candida parapsilosis, 16% were caused by Candida tropicalis, and 3% were caused by Candida krusei. Twenty-five percent of the patients were premature infants. Other underlying conditions included malignancy (15%); cardiac disease (14%); and short-gut syndrome (14%). A central venous catheter was in place during 61 (87%) of 70 episodes. Candiduria preceded candidemia in only 4 (8%) of 52 patients. The overall mortality rate was 19%; 36% of those with intravenous catheters that were not removed within 3 days died, whereas none of the patients from whom catheters were removed within 3 days died (P < .0001). Only two survivors had complications. Therapy with amphotericin B (with or without flucytosine) was administered to 74% of these patients. Seventeen patients were not treated medically; all were immunocompetent and survived. Of these patients, 15 were >2 months of age; 14 had candidemia for ⩽2 days; and 15 had an intravenous catheter removed within 2 days of the onset of candidemia. No patient stopped receiving amphotericin B because of side effects. The results of this study suggest the following: that mortality associated with candidemia is lower among children than among adults; that failure to remove the indwelling intravenous catheter usually results in a poor outcome; that candiduria rarely precedes candidemia in children; and that amphotericin B is well tolerated by children.