Mei-Yin Lai1,2, Jen-Fu Hsu1,2, Shih-Ming Chu1,2, I-Hsyuan Wu1,2, Hsuan-Rong Huang1,2, Chun-Chih Lin3, I-Ta Lee4, Ming-Chou Chiang1,2, Ren-Huei Fu1,2, Ming-Horng Tsai5,2. 1. Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 2. College of Medicine, Chang Gung University, Taoyuan, Taiwan. 3. Department of Nursing, Division of Basic Medical Sciences & Research Center for Industry of Human Ecology, Chang Gung University of Science & Technology, Chiayi, Taiwan. 4. Department of Anatomy, College of Medicine, China Medical University, Taichung, Taiwan. 5. Division of Neonatology & Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan.
Abstract
AIM: To assess the characteristics, treatments, risk factors and outcomes of breakthrough candidemia in children. MATERIALS & METHODS: Episodes of breakthrough candidemia in children were compared with the remaining episodes in a 13-year cohort study. RESULTS: Out of 319 episodes, 45 (14.1%) were breakthrough candidemia. Breakthrough candidemia occurred in patients with more acutely ill conditions, and the majority was caused by non-albicans Candida species (73.3%; 33 episodes). A total of 79.1% of breakthrough candidemia were caused by antifungal-susceptible Candida isolates and emergence of resistance was the mechanism in five cases of patients receiving fluconazole. Episodes of breakthrough candidemia had significantly higher illness severity and higher rates of fungemia-attributable mortality. CONCLUSION: Breakthrough candidemia independently contributed to unfavorable outcomes, and more aggressive treatment strategies are warranted when breakthrough candidemia is encountered.
AIM: To assess the characteristics, treatments, risk factors and outcomes of breakthrough candidemia in children. MATERIALS & METHODS: Episodes of breakthrough candidemia in children were compared with the remaining episodes in a 13-year cohort study. RESULTS: Out of 319 episodes, 45 (14.1%) were breakthrough candidemia. Breakthrough candidemia occurred in patients with more acutely ill conditions, and the majority was caused by non-albicans Candida species (73.3%; 33 episodes). A total of 79.1% of breakthrough candidemia were caused by antifungal-susceptible Candida isolates and emergence of resistance was the mechanism in five cases of patients receiving fluconazole. Episodes of breakthrough candidemia had significantly higher illness severity and higher rates of fungemia-attributable mortality. CONCLUSION:Breakthrough candidemia independently contributed to unfavorable outcomes, and more aggressive treatment strategies are warranted when breakthrough candidemia is encountered.
Authors: Anabel Piqueras; Lakshmi Ganapathi; Jane F Carpenter; Thomas Rubio; Thomas J Sandora; Kelly B Flett; Julia R Köhler Journal: J Fungi (Basel) Date: 2021-01-22