TY - JOUR
T1 - Adjunctive Diagnostic Studies Completed Following Detection of Candidemia in Children
T2 - Secondary Analysis of Observed Practice From a Multicenter Cohort Study Conducted by the Pediatric Fungal Network
AU - Wattier, Rachel L.
AU - Bucayu, Robert F.T.
AU - Boge, Craig L.K.
AU - Ross, Rachael K.
AU - Yildirim, Inci
AU - Zaoutis, Theoklis E.
AU - Palazzi, Debra L.
AU - Vora, Surabhi B.
AU - Castagnola, Elio
AU - Avilés-Robles, Martha
AU - Danziger-Isakov, Lara
AU - Tribble, Alison C.
AU - Sharma, Tanvi S.
AU - Arrieta, Antonio C.
AU - Maron, Gabriela
AU - Berman, David M.
AU - Yin, Dwight E.
AU - Sung, Lillian
AU - Green, Michael
AU - Roilides, Emmanuel
AU - Belani, Kiran
AU - Romero, José
AU - Soler-Palacin, Pere
AU - López-Medina, Eduardo
AU - Nolt, Dawn
AU - Bin Hussain, Ibrahim Zaid
AU - Muller, William J.
AU - Hauger, Sarmistha B.
AU - Halasa, Natasha
AU - Dulek, Daniel
AU - Pong, Alice
AU - Gonzalez, Blanca E.
AU - Abzug, Mark J.
AU - Carlesse, Fabianne
AU - Huppler, Anna R.
AU - Rajan, Sujatha
AU - Aftandilian, Catherine
AU - Ardura, Monica I.
AU - Chakrabarti, Arunaloke
AU - Hanisch, Benjamin
AU - Salvatore, Christine M.
AU - Klingspor, Lena
AU - Knackstedt, Elizabeth D.
AU - Lutsar, Irja
AU - Santolaya, Maria E.
AU - Shuster, Sydney
AU - Johnson, Sarah K.
AU - Steinbach, William J.
AU - Fisher, Brian T.
N1 - Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - 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.
AB - 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.
KW - candidemia
KW - endocarditis
KW - endophthalmitis
KW - invasive candidiasis
KW - pediatrics
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U2 - 10.1093/jpids/piad057
DO - 10.1093/jpids/piad057
M3 - Article
C2 - 37589394
AN - SCOPUS:85172740128
SN - 2048-7193
VL - 12
SP - 487
EP - 495
JO - Journal of the Pediatric Infectious Diseases Society
JF - Journal of the Pediatric Infectious Diseases Society
IS - 9
ER -