Lars Jørgen Østergaard

Pediatric Candidemia Epidemiology and Morbidities: A Nationwide Cohort

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Karen Rokkedal Lausch
  • ,
  • Kia Hee Schultz Dungu, Dpt. of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.
  • ,
  • Michael Thude Callesen, Dpt. of Pediatric, Odense University Hospital, Odense, Denmark.
  • ,
  • Henrik Schrøder
  • ,
  • Steen Rosthøj, Dpt. of Pediatric, Aalborg University Hospital, Aalborg, Denmark.
  • ,
  • Anja Poulsen, Dpt. of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.
  • ,
  • Lars Østergaard
  • Klaus Leth Mortensen
  • Merete Storgaard
  • Henrik C Schønheyder
  • Mette Søgaard, Dpt. of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Aalborg Thrombosis Research Unit, Dpt. of Clinical Medicine, Aalborg University, Aalborg, Denmark.
  • ,
  • Maiken C Arendrup, Dpt. of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

INTRODUCTION: Candidemia is the most frequent pediatric fungal infection, but incompletely elucidated in population-based settings. We performed a nationwide cohort study including all pediatric patients with candidemia in Denmark from 2004-2014 to determine age, incidence, species distribution, underlying diseases, patient management and outcomes.

METHODS: All candidemia episodes were identified through the active nationwide fungemia surveillance program. Susceptibility testing followed the EUCAST E.Def 7 reference method. Chi-squared test, Fisher's exact test and Venn diagrams were used for statistical analyses.

RESULTS: 153 pediatric patients (≤15 years) with 158 candidemia episodes were identified. The overall annual incidence rate was 1.3/100,000 population, higher for neonates (5.7/100,000 live births) and low birth weight (LBW) neonates (103.8/100.000 live births). From 2004-9 to 2010-2014, the proportion of C. albicans decreased from 74.4% to 64.7%, whereas fluconazole resistance increased from 7.8% to 17.7%. Virtually all patients had at least one underlying disease (98.6%) and multi-morbidity was common (43.5%, ≥2 underlying diseases). Underlying diseases differed by age with heart malformations and gastrointestinal disease prevalent in children younger than 3 years. The overall 30-days mortality was 10.2% and highest for neonates (17.1%). Mortality increased from 2004- to 2010-14, driven by an increase among older children.

DISCUSSION: This first nationwide epidemiologic study of pediatric candidemia confirmed a high incidence among neonates and a substantial burden of comorbidities. Moreover, an increasing proportion of fluconazole resistant non-albicans species was observed. Our findings underline the importance of choosing correct treatment and continuous surveillance of pediatric candidemia.

Original languageEnglish
JournalThe Pediatric Infectious Disease Journal
Volume38
Issue5
Pages (from-to)464-469
Number of pages6
ISSN0891-3668
DOIs
Publication statusPublished - 2019

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