Breakthrough candidemia in children: clinical and microbiological characteristics, therapeutic strategies and impact on outcomes.
To assess the characteristics, treatments, risk factors and outcomes of breakthrough candidemia in children.



Episodes of breakthrough candidemia in children were compared with the remaining episodes in a 13-year cohort study.



Out of 319 episodes, 45 (14.1%) were breakthrough candidemia. Breakthrough candidemia occurred in patients with more acutely ill conditions, and the majority was caused by non-albicans Candida species (73.3%; 33 episodes). A total of 79.1% of breakthrough candidemia were caused by antifungal-susceptible Candida isolates and emergence of resistance was the mechanism in five cases of patients receiving fluconazole. Episodes of breakthrough candidemia had significantly higher illness severity and higher rates of fungemia-attributable mortality.



Breakthrough candidemia independently contributed to unfavorable outcomes, and more aggressive treatment strategies are warranted when breakthrough candidemia is encountered.
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Mei-Yin
MY
Lai
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Jen-Fu
JF
Hsu
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Shih-Ming
SM
Chu
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
I-Hsyuan
IH
Wu
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Hsuan-Rong
HR
Huang
Department of Nursing, Division of Basic Medical Sciences & Research Center for Industry of Human Ecology, Chang Gung University of Science & Technology, Chiayi, Taiwan.
Chun-Chih
CC
Lin
Department of Anatomy, College of Medicine, China Medical University, Taichung, Taiwan.
I-Ta
IT
Lee
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ming-Chou
MC
Chiang
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ren-Huei
RH
Fu
Division of Neonatology & Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ming-Horng
MH
Tsai
D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002177:Candidiasis / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D058365:Candidiasis, Invasive / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D025141:Drug Resistance, Fungal / Q000187:drug effects; D054714:Echinocandins / Q000627:therapeutic use; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins
antifungal susceptibility; bloodstream infection; candidemia; invasive candidiasis; mortality