Adjunctive Diagnostic Studies Completed Following Detection of Candidemia in Children: Secondary Analysis of Observed Practice From a Multicenter Cohort Study Conducted by the Pediatric Fungal Network

Author:

Wattier Rachel L1,Bucayu Robert F T1,Boge Craig L K2,Ross Rachael K3,Yildirim Inci4567,Zaoutis Theoklis E2,Palazzi Debra L8,Vora Surabhi B9,Castagnola Elio10,Avilés-Robles Martha11,Danziger-Isakov Lara12,Tribble Alison C13,Sharma Tanvi S14,Arrieta Antonio C1516,Maron Gabriela17,Berman David M18,Yin Dwight E19ORCID,Sung Lillian20,Green Michael21,Roilides Emmanuel22ORCID,Belani Kiran23,Romero José24,Soler-Palacin Pere25ORCID,López-Medina Eduardo26ORCID,Nolt Dawn27,Bin Hussain Ibrahim Zaid28,Muller William J29,Hauger Sarmistha B30,Halasa Natasha31,Dulek Daniel31,Pong Alice32,Gonzalez Blanca E33,Abzug Mark J34,Carlesse Fabianne35,Huppler Anna R36,Rajan Sujatha37,Aftandilian Catherine38,Ardura Monica I39ORCID,Chakrabarti Arunaloke40ORCID,Hanisch Benjamin41ORCID,Salvatore Christine M42ORCID,Klingspor Lena43,Knackstedt Elizabeth D44,Lutsar Irja45,Santolaya Maria E46,Shuster Sydney2,Johnson Sarah K47,Steinbach William J47,Fisher Brian T248ORCID

Affiliation:

1. Department of Pediatrics, University of California San Francisco , San Francisco, California , USA

2. Department of Pediatrics, Children’s Hospital of Philadelphia , Philadelphia, Pennsylvania , USA

3. Department of Epidemiology, University of North Carolina Chapel Hill , Chapel Hill, North Carolina , USA

4. Department of Pediatrics, Yale University School of Medicine , Connecticut , USA

5. Yale Institute for Global Health, Yale University , New Haven, Connecticut , USA

6. Yale Center for Infection and Immunity , New Haven, Connecticut , USA

7. Department of Epidemiology, Yale School of Public Health , New Haven, Connecticut , USA

8. Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital , Houston, Texas , USA

9. Department of Pediatrics, University of Washington, Division of Infectious Diseases, Seattle Children’s Hospital , Seattle, Washington , USA

10. Department of Pediatrics, IRCCS Istituto Giannina Gaslini , Genoa , Italy

11. Department of Infectious Diseases, Hospital Infantil de México Federico Gómez , Mexico City , Mexico

12. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati , Cincinnati, Ohio , USA

13. Division of Infectious Diseases, Department of Pediatrics, University of Michigan and C.S. Mott Children’s Hospital , Ann Arbor, Michigan , USA

14. Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School , Boston, Massachusetts , USA

15. Department of Infectious Diseases, Children’s Hospital of Orange County , Orange, California , USA

16. Department of Pediatrics, University of California Irvine , Irvine, California , USA

17. Department of Infectious Diseases, St. Jude Children’s Research Hospital , Memphis, Tennessee , USA

18. Division of Pediatric Infectious Diseases, Johns Hopkins All Children’s Hospital , St. Petersburg, Florida , USA

19. Department of Pediatrics, Children’s Mercy and University of Missouri-Kansas City School of Medicine , Kansas City, Missouri , USA

20. Division of Haematology/Oncology, The Hospital for Sick Children , Toronto , Canada

21. Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC , Pittsburgh, Pennsylvania , USA

22. Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University and Hippokration Hospital , Thessaloniki , Greece

23. Pediatric Infectious Diseases, Children’s Minnesota , Minneapolis, Minnesota , USA

24. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA

25. Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron , Barcelona, Catalonia , Spain

26. Centro de Estudios en Infectología Pediátrica, Clínica Imbanaco Grupo Quirónsalud and Universidad del Valle , Cali , Colombia

27. Department of Pediatrics, Oregon Health and Science University and Doernbecher Children’s Hospital , Portland, Oregon , USA

28. Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Center , Riyadh , Saudi Arabia

29. Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine , Chicago, Illinois , USA

30. Department of Pediatrics, University of Texas at Austin and Dell Children’s Medical Center , Austin, Texas , USA

31. Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt , Nashville, Tennessee , USA

32. Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego , San Diego, California , USA

33. Center for Pediatric Infectious Diseases, Cleveland Clinic Foundation , Cleveland, Ohio , USA

34. Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado , Aurora, Colorado , USA

35. Instituto de Oncologia Pediatrica–IOP/GRAACC-UNIFESP , São Paulo , Brazil

36. Department of Pediatrics, Medical College of Wisconsin and Children’s Wisconsin , Milwaukee, Wisconsin , USA

37. Division of Pediatric Infectious Diseases, Cohen Children’s Medical Center , New Hyde Park, New York , USA

38. Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California , USA

39. Division of Infectious Diseases and Host Defense Program, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University , Columbus, Ohio , USA

40. Doodhadhar Burfani Hospital and Research Institute , Haridwar , India

41. Pediatric Infectious Diseases, Children’s National Health System , Washington, District of Columbia , USA

42. Division of Pediatric Infectious Diseases, Weill Cornell Medicine and Komansky Children’s Hospital , New York, New York , USA

43. Department of Laboratory Medicine, Karolinska Institute , Stockholm , Sweden

44. Department of Pediatrics, University of Utah , Salt Lake City, Utah , USA

45. Department of Microbiology, University of Tartu , Tartu , Estonia

46. Hospital Dr. Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile , Santiago , Chile

47. Department of Pediatrics, University of Arkansas for Medical Sciences , Little Rock, Arkansas , USA

48. Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania , USA

Abstract

Abstract Background Adjunctive diagnostic studies (aDS) are recommended to identify occult dissemination in patients with candidemia. Patterns of evaluation with aDS across pediatric settings are unknown. Methods Candidemia episodes were included in a secondary analysis of a multicenter comparative effectiveness study that prospectively enrolled participants age 120 days to 17 years with invasive candidiasis (predominantly candidemia) from 2014 to 2017. Ophthalmologic examination (OE), abdominal imaging (AbdImg), echocardiogram, neuroimaging, and lumbar puncture (LP) were performed per clinician discretion. Adjunctive diagnostic studies performance and positive results were determined per episode, within 30 days from candidemia onset. Associations of aDS performance with episode characteristics were evaluated via mixed-effects logistic regression. Results In 662 pediatric candidemia episodes, 490 (74%) underwent AbdImg, 450 (68%) OE, 426 (64%) echocardiogram, 160 (24%) neuroimaging, and 76 (11%) LP; performance of each aDS per episode varied across sites up to 16-fold. Longer durations of candidemia were associated with undergoing OE, AbdImg, and echocardiogram. Immunocompromised status (58% of episodes) was associated with undergoing AbdImg (adjusted odds ratio [aOR] 2.38; 95% confidence intervals [95% CI] 1.51–3.74). Intensive care at candidemia onset (30% of episodes) was associated with undergoing echocardiogram (aOR 2.42; 95% CI 1.51–3.88). Among evaluated episodes, positive OE was reported in 15 (3%), AbdImg in 30 (6%), echocardiogram in 14 (3%), neuroimaging in 9 (6%), and LP in 3 (4%). Conclusions Our findings show heterogeneity in practice, with some clinicians performing aDS selectively, potentially influenced by clinical factors. The low frequency of positive results suggests that targeted application of aDS is warranted.

Funder

National Institute of Allergy and Infectious Diseases

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,General Medicine,Pediatrics, Perinatology and Child Health

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