Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia

Abstract We aimed to determine the clinical and microbiological characteristics of Candida bloodstream infections in children and the impact of therapeutic strategies on outcomes. All pediatric patients with candidemia from a medical center in Taiwan over a 13-year period (2003–2015) were included a...

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Autores principales:	Ming-Horng Tsai, Jen-Fu Hsu, Shih-Ming Chu, Pey-Jium Chang, Mei-Yin Lai, I-Hsyuan Wu, Hsuan-Rong Huang, Ming-Chou Chiang, Ren-Huei Fu, Jang-Jih Lu
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2017
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7ec9d143d58b4962ae0c7f9790dddea5
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spelling	oai:doaj.org-article:7ec9d143d58b4962ae0c7f9790dddea52021-12-02T12:32:27ZClinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia10.1038/s41598-017-01123-62045-2322https://doaj.org/article/7ec9d143d58b4962ae0c7f9790dddea52017-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-017-01123-6https://doaj.org/toc/2045-2322Abstract We aimed to determine the clinical and microbiological characteristics of Candida bloodstream infections in children and the impact of therapeutic strategies on outcomes. All pediatric patients with candidemia from a medical center in Taiwan over a 13-year period (2003–2015) were included and a total of 262 patients with 319 episodes of candidemia were analyzed. Overall susceptibility to fluconazole was 86.1%. Cumulative mortality at 7 and 30 days after the first episode of candidemia was 13.4% and 25.2%, respectively. The overall in-hospital mortality rate was 35.1%. The treatment outcomes did not change over the study period. Multivariate analysis showed that delayed catheter removal (odds ratio [OR], 5.52; 95% confidence interval [CI]: 2.97–10.25), septic shock (OR, 5.49; 95% CI: 2.85–10.57), and breakthrough candidemia (OR, 3.66; 95% CI: 1.43–9.35) were independently associated with clinical treatment failure. In children with candidemia, underlying renal insufficiency and hematological/oncological malignancy, delayed catheter removal, and septic shock at onset were independently associated final in-hospital mortality. Analyzing the subgroup of non-neonatal children did not change the findings. We concluded overall mortality of pediatric candidemia remains high during the past decade. Prompt early catheter removal and aggressive treatment strategy in patients with septic shock would be critical to improve outcomes.Ming-Horng TsaiJen-Fu HsuShih-Ming ChuPey-Jium ChangMei-Yin LaiI-Hsyuan WuHsuan-Rong HuangMing-Chou ChiangRen-Huei FuJang-Jih LuNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 7, Iss 1, Pp 1-9 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ming-Horng Tsai Jen-Fu Hsu Shih-Ming Chu Pey-Jium Chang Mei-Yin Lai I-Hsyuan Wu Hsuan-Rong Huang Ming-Chou Chiang Ren-Huei Fu Jang-Jih Lu Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia
description	Abstract We aimed to determine the clinical and microbiological characteristics of Candida bloodstream infections in children and the impact of therapeutic strategies on outcomes. All pediatric patients with candidemia from a medical center in Taiwan over a 13-year period (2003–2015) were included and a total of 262 patients with 319 episodes of candidemia were analyzed. Overall susceptibility to fluconazole was 86.1%. Cumulative mortality at 7 and 30 days after the first episode of candidemia was 13.4% and 25.2%, respectively. The overall in-hospital mortality rate was 35.1%. The treatment outcomes did not change over the study period. Multivariate analysis showed that delayed catheter removal (odds ratio [OR], 5.52; 95% confidence interval [CI]: 2.97–10.25), septic shock (OR, 5.49; 95% CI: 2.85–10.57), and breakthrough candidemia (OR, 3.66; 95% CI: 1.43–9.35) were independently associated with clinical treatment failure. In children with candidemia, underlying renal insufficiency and hematological/oncological malignancy, delayed catheter removal, and septic shock at onset were independently associated final in-hospital mortality. Analyzing the subgroup of non-neonatal children did not change the findings. We concluded overall mortality of pediatric candidemia remains high during the past decade. Prompt early catheter removal and aggressive treatment strategy in patients with septic shock would be critical to improve outcomes.
format	article
author	Ming-Horng Tsai Jen-Fu Hsu Shih-Ming Chu Pey-Jium Chang Mei-Yin Lai I-Hsyuan Wu Hsuan-Rong Huang Ming-Chou Chiang Ren-Huei Fu Jang-Jih Lu
author_facet	Ming-Horng Tsai Jen-Fu Hsu Shih-Ming Chu Pey-Jium Chang Mei-Yin Lai I-Hsyuan Wu Hsuan-Rong Huang Ming-Chou Chiang Ren-Huei Fu Jang-Jih Lu
author_sort	Ming-Horng Tsai
title	Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia
title_short	Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia
title_full	Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia
title_fullStr	Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia
title_full_unstemmed	Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia
title_sort	clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia
publisher	Nature Portfolio
publishDate	2017
url	https://doaj.org/article/7ec9d143d58b4962ae0c7f9790dddea5
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Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia

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