title: Results from a prospective, international, epidemiologic study of invasive candidiasis in children and neonates.
abstract: BACKGROUND
  Candida species are the third most common cause of pediatric health care-associated bloodstream infection in the United States and Europe. To our knowledge, this report from the International Pediatric Fungal Network is the largest prospective, multicenter observational study dedicated to pediatric and neonatal invasive candidiasis.
  
  
  METHODS
  From 2007 to 2011, we enrolled 196 pediatric and 25 neonatal patients with invasive candidiasis.
  
  
  RESULTS
  Non-albicans Candida species predominated in pediatric (56%) and neonatal (52%) age groups, yet Candida albicans was the most common species in both groups. Successful treatment responses were observed in pediatric (76%) and neonatal patients (92%). Infection with Candida parapsilosis led to successful responses in pediatric (92%) and neonatal (100%) patients, whereas infection with Candida glabrata was associated with a lower successful outcome in pediatric patients (55%). The most commonly used primary antifungal therapies for pediatric invasive candidiasis were fluconazole (21%), liposomal amphotericin B (20%) and micafungin (18%). Outcome of pediatric invasive candidiasis was similar in response to polyenes (73%), triazoles (67%) and echinocandins (73%). The most commonly used primary antifungal therapies for neonatal invasive candidiasis were fluconazole (32%), caspofungin (24%) and liposomal amphotericin B (16%) and micafungin (8%). Outcomes of neonatal candidiasis by antifungal class again revealed similar response rates among the classes.
  
  
  CONCLUSIONS
  We found a predominance of non-albicans Candida infection in children and similar outcomes based on antifungal class used. This international collaborative study sets the foundation for large epidemiologic studies focusing on the unique features of neonatal and pediatric candidiasis and comparative studies of therapeutic interventions in these populations.
authors.affiliation: Duke University, Durham, NC 27710 , USA. bill.steinbach@duke.edu
authors.forename: William J
authors.initials: WJ
authors.lastname: Steinbach
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
authors.forename: David
authors.initials: D
authors.lastname: Berman
authors.forename: Jill A
authors.initials: JA
authors.lastname: Hoffman
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Groll
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Bin-Hussain
authors.forename: Debra L
authors.initials: DL
authors.lastname: Palazzi
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.forename: Natasha
authors.initials: N
authors.lastname: Halasa
authors.forename: Aristea
authors.initials: A
authors.lastname: Velegraki
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Dvorak
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Charkabarti
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
authors.forename: Lara
authors.initials: L
authors.lastname: Danziger-Isakov
authors.forename: Catherine
authors.initials: C
authors.lastname: Lachenauer
authors.forename: Antonio
authors.initials: A
authors.lastname: Arrieta
authors.forename: Katherine
authors.initials: K
authors.lastname: Knapp
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Abzug
authors.forename: Christine
authors.initials: C
authors.lastname: Ziebold
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehrnbecher
authors.forename: Lena
authors.initials: L
authors.lastname: Klingspor
authors.forename: Adilia
authors.initials: A
authors.lastname: Warris
authors.forename: Kateri
authors.initials: K
authors.lastname: Leckerman
authors.forename: Teresa
authors.initials: T
authors.lastname: Martling
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D016021:Epidemiologic Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents