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Species-based comparison of disease severity and risk factors for disseminated Candida infections in pediatric patients

Authors Hawkshead III JJ, Van Dyke RB, Hassig SE, Webber LS, Begue RE

Received 15 December 2015

Accepted for publication 7 March 2016

Published 18 April 2016 Volume 2016:9 Pages 59—70


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Professor Suresh Antony

John J Hawkshead III,1 Russell B Van Dyke,2 Susan E Hassig,3 Larry S Webber,4 Rodolfo E Begue5

1Merck & Co, CORE Hospital Specialty Group, Rahway, NJ, 2Department of Pediatrics, Tulane University School of Medicine, 3Department of Epidemiology, 4Department of Biostatistics, Tulane University School of Public Health and Tropical Medicine, 5Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA

Background: Pediatric Candida infections are associated with worse clinical outcomes and increased costs. Yet, it is not definitively known if particular species are associated with more severe illness. Differential risk factor exposures among the species group may also exist. We aimed to determine whether certain Candida species are more strongly associated with worse outcomes, and whether certain risk factors more strongly predispose patients to infection with certain species.
Methods: Microbiology lab records from patients seen from 2003 to 2010 at an urban children's hospital were reviewed for invasive or disseminated Candida infections. Data on measures of disease severity/outcome and risk factors were abstracted and analyzed to determine differences associated with various Candida species.
Results: Exactly 106 cases of infection were analyzed. Non-albicans species were associated with a significantly longer length of stay postdiagnosis (P=0.03), as well as longer treatment (P=0.02). Candida albicans was associated with a higher number of antihypotensive medications required (P=0.03) and length of mechanical ventilation postdiagnosis (P=0.05). Candida tropicalis was associated with the highest mortality (45.5%). Hypotension, which was found to be significantly associated with concurrent infection, was significantly associated with increased risk of mortality (odds ratio =5.85, P=0.005). Initial choice of antifungal therapy was not associated with differences in eventual patient mortality. Multivariate logistic regression modeling revealed a trend toward C. albicans infection in patients receiving antineoplastic chemotherapy and non-albicans infection in patients with >96 hours mechanical ventilation.
Conclusion: Interspecies differences may exist for Candida in terms of disease severity and risk factors. Underlying morbidity and the role of concurrent infections may play a key role in poor outcomes.

Keywords: Candida, disseminated, pediatric, severity, risk factors, fungemia, antifungal, coinfection

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