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Adjunctive Diagnostic Studies Completed Following Detection of Candidemia in Children: Secondary Analysis of Observed Practice From a Multicenter Cohort Study Conducted by the Pediatric Fungal Network.
Wattier, Rachel L; Bucayu, Robert F T; Boge, Craig L K; Ross, Rachael K; Yildirim, Inci; Zaoutis, Theoklis E; Palazzi, Debra L; Vora, Surabhi B; Castagnola, Elio; Avilés-Robles, Martha; Danziger-Isakov, Lara; Tribble, Alison C; Sharma, Tanvi S; Arrieta, Antonio C; Maron, Gabriela; Berman, David M; Yin, Dwight E; Sung, Lillian; Green, Michael; Roilides, Emmanuel; Belani, Kiran; Romero, José; Soler-Palacin, Pere; López-Medina, Eduardo; Nolt, Dawn; Bin Hussain, Ibrahim Zaid; Muller, William J; Hauger, Sarmistha B; Halasa, Natasha; Dulek, Daniel; Pong, Alice; Gonzalez, Blanca E; Abzug, Mark J; Carlesse, Fabianne; Huppler, Anna R; Rajan, Sujatha; Aftandilian, Catherine; Ardura, Monica I; Chakrabarti, Arunaloke; Hanisch, Benjamin; Salvatore, Christine M; Klingspor, Lena; Knackstedt, Elizabeth D; Lutsar, Irja; Santolaya, Maria E; Shuster, Sydney; Johnson, Sarah K; Steinbach, William J; Fisher, Brian T.
Afiliação
  • Wattier RL; Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
  • Bucayu RFT; Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
  • Boge CLK; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
  • Ross RK; Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA.
  • Yildirim I; Department of Pediatrics, Yale University School of Medicine, Connecticut, USA.
  • Zaoutis TE; Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA.
  • Palazzi DL; Yale Center for Infection and Immunity, New Haven, Connecticut, USA.
  • Vora SB; Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA.
  • Castagnola E; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
  • Avilés-Robles M; Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
  • Danziger-Isakov L; Department of Pediatrics, University of Washington, Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington, USA.
  • Tribble AC; Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
  • Sharma TS; Department of Infectious Diseases, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
  • Arrieta AC; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.
  • Maron G; Division of Infectious Diseases, Department of Pediatrics, University of Michigan and C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA.
  • Berman DM; Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Yin DE; Department of Infectious Diseases, Children's Hospital of Orange County, Orange, California, USA.
  • Sung L; Department of Pediatrics, University of California Irvine, Irvine, California, USA.
  • Green M; Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
  • Roilides E; Division of Pediatric Infectious Diseases, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
  • Belani K; Department of Pediatrics, Children's Mercy and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
  • Romero J; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
  • Soler-Palacin P; Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
  • López-Medina E; Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University and Hippokration Hospital, Thessaloniki, Greece.
  • Nolt D; Pediatric Infectious Diseases, Children's Minnesota, Minneapolis, Minnesota, USA.
  • Bin Hussain IZ; National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Muller WJ; Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.
  • Hauger SB; Centro de Estudios en Infectología Pediátrica, Clínica Imbanaco Grupo Quirónsalud and Universidad del Valle, Cali, Colombia.
  • Halasa N; Department of Pediatrics, Oregon Health and Science University and Doernbecher Children's Hospital, Portland, Oregon, USA.
  • Dulek D; Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Pong A; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
  • Gonzalez BE; Department of Pediatrics, University of Texas at Austin and Dell Children's Medical Center, Austin, Texas, USA.
  • Abzug MJ; Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
  • Carlesse F; Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
  • Huppler AR; Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, California, USA.
  • Rajan S; Center for Pediatric Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
  • Aftandilian C; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
  • Ardura MI; Instituto de Oncologia Pediatrica-IOP/GRAACC-UNIFESP, São Paulo, Brazil.
  • Chakrabarti A; Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA.
  • Hanisch B; Division of Pediatric Infectious Diseases, Cohen Children's Medical Center, New Hyde Park, New York, USA.
  • Salvatore CM; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.
  • Klingspor L; Division of Infectious Diseases and Host Defense Program, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.
  • Knackstedt ED; Doodhadhar Burfani Hospital and Research Institute, Haridwar, India.
  • Lutsar I; Pediatric Infectious Diseases, Children's National Health System, Washington, District of Columbia, USA.
  • Santolaya ME; Division of Pediatric Infectious Diseases, Weill Cornell Medicine and Komansky Children's Hospital, New York, New York, USA.
  • Shuster S; Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
  • Johnson SK; Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
  • Steinbach WJ; Department of Microbiology, University of Tartu, Tartu, Estonia.
  • Fisher BT; Hospital Dr. Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
J Pediatric Infect Dis Soc ; 12(9): 487-495, 2023 Sep 27.
Article em En | MEDLINE | ID: mdl-37589394
ABSTRACT

BACKGROUND:

Adjunctive diagnostic studies (aDS) are recommended to identify occult dissemination in patients with candidemia. Patterns of evaluation with aDS across pediatric settings are unknown.

METHODS:

Candidemia episodes were included in a secondary analysis of a multicenter comparative effectiveness study that prospectively enrolled participants age 120 days to 17 years with invasive candidiasis (predominantly candidemia) from 2014 to 2017. Ophthalmologic examination (OE), abdominal imaging (AbdImg), echocardiogram, neuroimaging, and lumbar puncture (LP) were performed per clinician discretion. Adjunctive diagnostic studies performance and positive results were determined per episode, within 30 days from candidemia onset. Associations of aDS performance with episode characteristics were evaluated via mixed-effects logistic regression.

RESULTS:

In 662 pediatric candidemia episodes, 490 (74%) underwent AbdImg, 450 (68%) OE, 426 (64%) echocardiogram, 160 (24%) neuroimaging, and 76 (11%) LP; performance of each aDS per episode varied across sites up to 16-fold. Longer durations of candidemia were associated with undergoing OE, AbdImg, and echocardiogram. Immunocompromised status (58% of episodes) was associated with undergoing AbdImg (adjusted odds ratio [aOR] 2.38; 95% confidence intervals [95% CI] 1.51-3.74). Intensive care at candidemia onset (30% of episodes) was associated with undergoing echocardiogram (aOR 2.42; 95% CI 1.51-3.88). Among evaluated episodes, positive OE was reported in 15 (3%), AbdImg in 30 (6%), echocardiogram in 14 (3%), neuroimaging in 9 (6%), and LP in 3 (4%).

CONCLUSIONS:

Our findings show heterogeneity in practice, with some clinicians performing aDS selectively, potentially influenced by clinical factors. The low frequency of positive results suggests that targeted application of aDS is warranted.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Candidemia / Candidíase Invasiva Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged80 / Child / Humans Idioma: En Revista: J Pediatric Infect Dis Soc Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Estados Unidos
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Candidemia / Candidíase Invasiva Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged80 / Child / Humans Idioma: En Revista: J Pediatric Infect Dis Soc Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Estados Unidos