title: Active surveillance of candidemia in children from Latin America: a key requirement for improving disease outcome.
abstract: BACKGROUND
  Active surveillance is necessary for improving the management and outcomes of patients with candidemia. The aim of this study was to describe the epidemiologic and clinical features of candidemia in pediatric patients in Latin America.
  
  
  METHODS
  Prospective, multicenter, surveillance study of candidemia in a pediatric population from 23 hospitals in 8 Latin America countries between November 2008 and October 2010.
  
  
  RESULTS
  Three hundred and two cases of candidemia were reported with a median incidence of 0.81/1000 admissions. Eighty nine (29%) were neonates. The main risk factors were prematurity, intensive care unit (ICU) admission, parenteral nutrition, respiratory disease and mechanical ventilation in neonates and malignancy, neutropenia, neurological disease and previous use of corticosteroids in children. The main species isolated in neonates and children were Candida albicans (43.8% and 35.7%), Candida parapsilosis (27.0% and 26.3%) and Candida tropicalis (14.6% and 14.6%), respectively. The most frequent antifungal therapy used in neonates and children was deoxycholate-amphotericin-B (43.8% and 29.1%) and fluconazole (28.1% and 53.1%). Seventeen neonates (19.1%) and 20 children (9.4%) did not receive antifungal therapy. The 30-day survival rate was 60% in neonates and 72% in children (P = 0.02). Survival was significantly higher in treated than in nontreated neonates (72% vs. 24%; P < 0.001). A multivariate analysis showed that independent predictors for 30-day mortality in children were renal disease (odds ratio: 4.38, 95% confidence interval: 1.92-10.1, P < 0.001) and receipt of corticosteroids (odds ratio: 2.08, 95% confidence interval: 1.04-4.17, P = 0.04).
  
  
  CONCLUSIONS
  To our knowledge, this is the first prospective, multicenter surveillance study of candidemia in children in Latin America. This epidemiologic information may provide us with methods to improve preventive, diagnostic and therapeutic strategies in our continent.
authors.affiliation: From the *Department of Pediatrics, Hospital Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile; †Hospital Escuela, Tegucigalpa, Honduras; ‡Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil; §Infectious Diseases Unit, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; ¶Hospital Vozandes, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador; ‖Hospital de Clínicas José de San Martín, Buenos Aires, Argentina; **Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia; ††Infectious Diseases Unit, Department of Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; ‡‡Infectious Unit, Hospital Vargas, Caracas, Venezuela; §§Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; ¶¶Department of Medicine, Universidad Cayetano Heredia, Lima, Perú; and ‖‖University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Santolaya
authors.forename: Tito
authors.initials: T
authors.lastname: Alvarado
authors.forename: Flavio
authors.initials: F
authors.lastname: Queiroz-Telles
authors.forename: Arnaldo L
authors.initials: AL
authors.lastname: Colombo
authors.forename: Jeanette
authors.initials: J
authors.lastname: Zurita
authors.forename: Iris N
authors.initials: IN
authors.lastname: Tiraboschi
authors.forename: Jorge Alberto
authors.initials: JA
authors.lastname: Cortes
authors.forename: Luis
authors.initials: L
authors.lastname: Thompson
authors.forename: Manuel
authors.initials: M
authors.lastname: Guzman
authors.forename: Jose
authors.initials: J
authors.lastname: Sifuentes
authors.forename: Juan I
authors.initials: JI
authors.lastname: Echevarría
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification; D058387:Candidemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D007843:Latin America / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents