Disseminated Disease After Candidemia in Children and Young Adults: Epidemiology, Diagnostic Evaluation and Risk Factors.
Pediatr Infect Dis J
; 43(4): 328-332, 2024 Apr 01.
Article
in En
| MEDLINE
| ID: mdl-38091489
ABSTRACT
BACKGROUND:
Treatment of candidemia may be complicated by hematogenous dissemination. Limited data exist to guide decision-making regarding the evaluation for disseminated disease. We sought to describe the epidemiology of invasive disease after candidemia, report the diagnostic evaluations performed and identify risk factors for disseminated disease.METHODS:
We performed a retrospective single-center study of candidemia from January 1, 2012 to December 31, 2022. Disseminated candidiasis was defined as radiologic findings consistent with end-organ disease, abnormal ophthalmologic exam or growth of Candida spp. from a sterile site after an episode of candidemia. A multilevel regression model was used to identify risk factors for dissemination.RESULTS:
The cohort included 124 patients with 144 episodes of candidemia. Twelve patients died before an evaluation for dissemination occurred. Only 107/132 patients underwent evaluation for dissemination. Tests obtained included abdominal imaging (93/132), echocardiography (91/132), neuroimaging (45/132) and chest imaging (38/132). A retinal examination was performed in 90/132 patients. Overall, 27/107 patients (25%) had disseminated disease. Frequently identified sites of dissemination were lungs and abdominal organs. Regression modeling identified prematurity [adjusted odds ratio (aOR) 11.88; 95% confidence interval (CI) 1.72-81.90] and mitochondrial and genetic disease (aOR 5.66; 95% CI 1.06-30.17) as risk factors for disseminated candidiasis. Each additional day of candidemia increased the odds of dissemination (aOR 1.36; 95% CI 1.12-1.66).DISCUSSION:
In a heterogeneous cohort of patients, disseminated candidiasis was common. Evaluation for disseminated disease was variable. Those with persistent candidemia had significantly increased risk of dissemination and should undergo a standardized evaluation for disseminated disease.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Candidiasis
/
Candidemia
Limits:
Adult
/
Child
/
Humans
Language:
En
Journal:
Pediatr Infect Dis J
Year:
2024
Document type:
Article