gms | German Medical Science

Objectives: Epidemiological data on bloodstream infections (BSIs) due to Candida spp in pediatric patients in Europe are sparse. The purpose of this observational single center cohort study is to continuously follow incidence, features and outcome of BSIs caused by Candida spp. among pediatric patients.

Patients and methods: The Münster Pediatric Candidemia Cohort (MPCC) is a single-center, retrospective observational cohort study initiated in August 1998. Key inclusion criterion is an episode of candidemia, defined as the isolation of Candida ≥ one blood cultures, in a pediatric patient admitted to the University Children’s Hospital. Blood samples are collected using BACTEC Peds Plus/F, BACTEC Plus Aerobic/F, BACTEC Plus Anaerobic/F and BACTEC Mycosis-IC/F bottles, and incubated in the BACTEC 9240 automated system (BD Diagnostics, Heidelberg, Germany). Cases are identified through review of the Medical Microbiology records, and patient data are captured by a pseudonymized case report form. Study design and data handling were reviewed and approved by the local ethics committee.

Results: During August 1998 to December 2014, 51 episodes of Candida BSIs were identified in 47 patients (mean age 8.0 years); four patients had two separate episodes of candidemia.Eleven episodes (22.4%) occurred during prophylactic or empiric antifungal therapy. Malignancy including allogeneic HSCT (23/47 (48.9%)) and congenital malformations/syndromes (9/47 (19.1%)) were the most common underlying disease. The most frequent features associated with candidemia were the use of broad-spectrum antibiotics at presentation (46/49 (93.9%)) or within ≤ two weeks (34/49 (69.4%)), the presence of a central venous catheter (45/49 (91.8%)), chemo-/immunosuppressive therapy within ≤ two weeks (23/49 (46.9%)) and previous bacterial BSIs (22/49 (44.9%)). Candida albicans was the most common species (25/51; 49%), followed by C. parapsilosis (9/51 (17.6%)) and C. glabrata (6/51 (11.8%)). There was no clear trend over time regarding the occurrence of non-albicans Candida species. None of the isolated strains tested was resistant to all first-line antifungal agents. Antifungal monotherapy was administered in 35, and combined therapy in 12 episodes. Central venous catheters were removed in 67.4% (31/46) of patients. Severe sepsis and septic shock occurred in ten episodes (19.6%), and metastatic dissemination in six of all evaluable episodes (11.7%). Overall, eighth children (17%) died within 30 days of the first diagnostic blood culture; the 100-day mortality rate was the same.

Conclusion: Candidemia remains a rare but life-threatening condition in hospitalized pediatric patients. Candida-associated BSIs occur predominantly in patients with severe underlying diseases requiring aggressive treatment and placement of central venous catheters. No trends over time in the proportion of C. albicans and non-albicans Candida species and in resistance to first line agents are to be observed.