Published online April 27, 2009
PEDIATRICS Vol. 123 No. 5 May 2009, pp. 1360-1368 (doi:10.1542/peds.2008-2055)
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ARTICLE

Not Just Little Adults: Candidemia Epidemiology, Molecular Characterization, and Antifungal Susceptibility in Neonatal and Pediatric Patients

Christopher C. Blyth, MBBSa, Sharon C. A. Chen, PhD, MBBS, FRACP, FRCPAa,b,c, Monica A. Slavin, MBBS, MD, FRACPd, Carol Serena, PhDb, Quoc Nguyen, BMedSc, MHA, MHIMe, Deborah Marriott, MBBS, FRCPA, FRACPe, David Ellis, BSc, MSc, PhD, FASM, FRCPAf, Wieland Meyer, MSc, PhDb,c, Tania C. Sorrell, MBBS, MD, FRACPa,c on behalf of members of the Australian Candidemia Study

a Centre for Infectious Diseases and Microbiology
b Molecular Mycology Research Laboratory, Westmead Hospital, New South Wales, Australia
c Faculty of Medicine, University of Sydney, New South Wales, Australia
d Department of Infectious Diseases, Peter MacCallum Cancer Centre and Centre of Clinical Research Excellence in Infectious Diseases, Royal Melbourne Hospital, Victoria, Australia
e Department of Microbiology and Infectious Diseases, St Vincent's Hospital, New South Wales, Australia
f Mycology Unit, Women's and Children's Hospital and School of Molecular and Biomedical Science, University of Adelaide, South Australia, Australia

OBJECTIVE. The purpose of this work was to identify differences in incidence, risk factors, microbiology, treatment, and clinical outcome of candidemia in neonates, children, and adults that might impact on management.

PATIENTS AND METHODS. Cases of candidemia in Australia were identified prospectively by blood culture surveillance over 3 years. Episodes of candidemia in neonatal, pediatric, and adult age groups were analyzed and compared.

RESULTS. Of 1005 incident cases, 33 occurred in neonates, 110 in children, and 862 in adults. The respective annual age-specific incidences were 4.4, 0.9, and 1.8 per 100 000 population. Prematurity and ICU admission were major risk factors in neonates. Hematologic malignancy and neutropenia were significantly more frequent in children than in neonates and adults. Diabetes, renal disease, hemodialysis, and recent surgery were more common in adults. Candidemia was attributed to a vascular access device in 58% of neonates, 70% of children, and 44% of adults. Candida albicans caused ~48% of cases in all of the age groups. Candida parapsilosis was significantly more common in neonates and children (42% and 38% vs 15%). Candida glabrata was infrequent in neonates and children (9% and 3% vs 17%). Significantly more isolates from children were susceptible to fluconazole compared with those from adults (95% vs 75%). Fluconazole-resistant candidal isolates were infrequent in all of the age groups. Neonates and children were more likely to receive amphotericin B compared with adults. Adults were more likely to receive fluconazole. Survival rates at 30 days were 78% in neonates, 90% in children, and 70% in adults.

CONCLUSIONS. This study identifies significant differences in candidemia in neonates, children, and adults. Neonatologists and pediatricians must consider age-specific differences when interpreting adult studies and developing treatment and prevention guidelines.

Key Words: candida • fungemia • candidiasis • infant • newborn • child • adult • antifungal agents

Abbreviations: OHCA—outpatient health care associated • CA—community acquired • PCR—polymerase chain reaction • CI—confidence interval • VAD—vascular access device • OR—odds ratio • MIC—minimum inhibitory concentration

Accepted Sep 2, 2008.


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