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Characteristics, outcome and risk factors for mortality of pediatric patients with ICU‐acquired candidemia in India: A multicenter prospective study

Mycoses Jul 22, 2020

Chakrabarti A, Sood P, Rudramurthy SM, et al. - As there are only few comprehensive studies on the observed variation in the epidemiology, clinical profile and outcome of pediatric candidemia by age, healthcare settings and prevalent Candida species, researchers conducted a nationwide study addressing these differences. They examined 398 variables spanning demography, clinical characteristics, microbiology, treatment and outcome among 487 children who contracted ICU‐acquired candidemia at 23 Indian tertiary care centers. Candidemia developed in both neonates and non‐neonatal children early after ICU admission. Neonates, in majority, were premature (63.7%) with low birth weight (57.1%). The common comorbidities were perinatal asphyxia (7.3%), pneumonia (8.2%), congenital heart disease (8.4%) and invasive procedures, and widespread use of antibiotics (94.1%) was reported. Both age‐groups had dominance of C. tropicalis (24.7%) and C. albicans (20.7%). Treatment with antifungals (66.5%) and removal of central catheters (44.8%) lagged behind. Although there was overall low resistance, attention is needed toward the emergence of resistant C. krusei and C. auris. The 30‐day crude mortality of 27.8% (neonates) and 29.4% (non‐neonates) were reported. Following were the independent predictors of 30‐day crude mortality in neonates: admission to public sector ICUs, mechanical ventilation, corticosteroid therapy, and antifungal therapy. Similarly, independent predictors for non‐neonates were admission to public sector ICUs, mechanical ventilation, exposure to carbapenems, and azole antifungal therapy. These findings emphasize undertaking appropriate intervention strategies to decrease candidemia morbidity and mortality.

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