Candidaemia, comorbidities most prevalent among neonates
There is a high incidence of candidaemia and a substantial burden of comorbidities among neonates as confirmed in a recent nationwide epidemiologic study of paediatric candidaemia. An increasing proportion of nonalbicans species resistant to fluconazole has also been observed.
The investigators identified 153 paediatric patients (aged ≤15 years) with 158 candidaemia episodes. Overall annual incidence rate was 1.3 per 100,000 population, with higher rates for neonates (5.7 per 100,000 live births) and low birth weight neonates (103.8 per 100,000 live births).
The proportion of Candida albicans from 2004–2009 to 2010–2014 showed a reduction from 74.4 percent to 64.7 percent. On the other hand, resistance to fluconazole increased from 7.8 percent to 17.7 percent.
At least one underlying disease was present in almost all patients (98.6 percent), and multimorbidity was common (43.5 percent; ≥2 underlying diseases). These underlying diseases varied by age, with heart malformations and gastrointestinal disease prevalent in children <3 years old.
Overall mortality rate for 30 days stood at 10.2 percent, with the highest proportion recorded among neonates (17.1 percent). An upsurge in mortality was observed from 2004 to 2010 to 2014 due to an increase among older children.
“Our findings underline the importance of choosing correct treatment and continuous surveillance of paediatric candidaemia,” the investigators said.
In this nationwide cohort study, all candidaemia episodes were identified through the active nationwide fungemia surveillance program. The EUCAST E.Def 7 (European Committee on Antifungal Susceptibility Testing, Edition Definitive) reference method was followed by susceptibility testing. The following were used for statistical analyses: χ2 test, Fisher exact test and Venn diagrams.
“Candidemia is the most frequent paediatric fungal infection but incompletely elucidated in population-based settings,” the investigators said.