Not just little adults: candidemia epidemiology, molecular characterization, and antifungal susceptibility in neonatal and pediatric patients.
OBJECTIVE
The purpose of this work was to identify differences in incidence, risk factors, microbiology, treatment, and clinical outcome of candidemia in neonates, children, and adults that might impact on management.


METHODS
Cases of candidemia in Australia were identified prospectively by blood culture surveillance over 3 years. Episodes of candidemia in neonatal, pediatric, and adult age groups were analyzed and compared.


RESULTS
Of 1005 incident cases, 33 occurred in neonates, 110 in children, and 862 in adults. The respective annual age-specific incidences were 4.4, 0.9, and 1.8 per 100,000 population. Prematurity and ICU admission were major risk factors in neonates. Hematologic malignancy and neutropenia were significantly more frequent in children than in neonates and adults. Diabetes, renal disease, hemodialysis, and recent surgery were more common in adults. Candidemia was attributed to a vascular access device in 58% of neonates, 70% of children, and 44% of adults. Candida albicans caused approximately 48% of cases in all of the age groups. Candida parapsilosis was significantly more common in neonates and children (42% and 38% vs 15%). Candida glabrata was infrequent in neonates and children (9% and 3% vs 17%). Significantly more isolates from children were susceptible to fluconazole compared with those from adults (95% vs 75%). Fluconazole-resistant candidal isolates were infrequent in all of the age groups. Neonates and children were more likely to receive amphotericin B compared with adults. Adults were more likely to receive fluconazole. Survival rates at 30 days were 78% in neonates, 90% in children, and 70% in adults.


CONCLUSIONS
This study identifies significant differences in candidemia in neonates, children, and adults. Neonatologists and pediatricians must consider age-specific differences when interpreting adult studies and developing treatment and prevention guidelines.
Blyth
Christopher C
CC
Centre for Infectious Diseases and Microbiology, Westmead Hospital, Hawkesbury Road, Westmend, New South Wales 2145, Australia. christopher.blyth@swahs.health.nsw.gov.au
Chen
Sharon C A
SC
Slavin
Monica A
MA
Serena
Carol
C
Nguyen
Quoc
Q
Marriott
Deborah
D
Ellis
David
D
Meyer
Wieland
W
Sorrell
Tania C
TC
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D002176:Candida albicans / Q000235:genetics; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016172:DNA Fingerprinting; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009369:Neoplasms / Q000453:epidemiology; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D018746:Systemic Inflammatory Response Syndrome / Q000382:microbiology / Q000401:mortality
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole