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Invasive candidiasis in pediatric intensive care in Greece: a nationwide study

L. Vogiatzi| S. Ilia| G. Sideri| E. Vagelakoudi| M. Vassilopoulou| M. Sdougka| G. Briassoulis| I. Papadatos| P. Kalabalikis| L. Sianidou| E. Roilides
Pediatric Original
Volume 39, Issue 12 / December , 2013

Pages 2188 - 2195

Abstract

Purpose

To record the practices for prevention and management of invasive candidiasis in the PICU and investigate the epidemiology of candidiasis and its outcome nationwide.

Methods

A multicenter national study among PICUs throughout Greece. A questionnaire referring to local practices of prevention and management of candidemia was filled in, and a retrospective study of episodes that occurred during 5 years was conducted in all seven Greek PICUs.

Results

Clinical practices regarding surveillance cultures, catheter replacement protocols and antibiotic use were similar, although the case mix differed. In all PICUs prophylactic antifungal treatment was administered in transplant and neutropenic oncology patients. Discrepancy existed between PICUs concerning the first-line antifungal agents and treatment duration of candidemia. Twenty-two candidemias were nationally recorded between 2005 and 2009 with a median incidence of 6.4 cases/1,000 admissions. Median age was 8.2 (0.3–16.6) years. Candidaalbicans was isolated in 45.4 % of episodes followed by Candidaparapsilosis (22.7 %). Common findings were presence of central venous and urinary catheters as well as mechanical ventilation and administration of antibiotics with anti-anaerobic activity in almost all patients with candidemia. Total parenteral nutrition was administered to five (22.7 %) patients. Most of the patients had a chronic underlying disease; five were oncology patients, and two-thirds of those with candidemia were colonized with Candida spp. Lipid amphotericin B formulations were the predominant therapeutic choice (54.5 %). Thirty-day mortality was 18.2 %.

Conclusion

This first national study adds information to the epidemiology of candidemia in critically ill children. In these special patients, candidemia has a relatively low incidence and tends toward non-albicansCandida preponderance.

Keywords

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