Management of invasive fungal infections in the pediatric intensive care unit

Issue title: Management of Infections in Pediatric Critical Care

Article type: Research Article

Authors: Chiotos, Kathleen^; | Fisher, Brian T.^{; ; ;} | Zaoutis, Theoklis^{; ; ; ;}

Affiliations: Division of Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA | Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA | Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA | Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA | Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA | Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

Note: [] Corresponding author: Kathleen Chiotos, MD, Division of Infectious Diseases, Abramson Research Building, Room 1202, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104, USA. Tel.: +1 215 313 9399; Fax: +1 215 5902025; E-mail: [email protected]

Abstract: Invasive candidiasis (IC) are the most common invasive fungal infections in pediatric intensive care unit patients due to commonly present risk factors including central venous catheters, antibiotic exposure, recent surgery, total parenteral nutrition, and prior colonization with Candida species. These infections are economically costly and have been associated with an attributable mortality of approximately 10%. As a result, investigators have attempted to identify cohorts of pediatric intensive care unit patients at highest risk of development of IC who may benefit from prophylactic, early empiric, or pre-emptive therapy. This review article will consider these prediction models and therapeutic approaches. Additionally, the management of confirmed IC, including anti-fungal therapeutic options, evaluation for disseminated disease, and management of central venous catheters, will be reviewed.

Keywords: Candida, candidiasis, anti-fungal agent, pediatrics, pediatric intensive care unit

DOI: 10.3233/PIC-14108

Journal: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 269-279, 2014