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.
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Wattier Rachel L, Bucayu Robert F T, Boge Craig L K, Ross Rachael K, Yildirim Inci, Zaoutis Theoklis E, Palazzi Debra L, Vora Surabhi B, Castagnola Elio, Avilés-Robles Martha, Danziger-Isakov Lara, Tribble Alison C, Sharma Tanvi S, Arrieta Antonio C, Maron Gabriela, Berman David M, Yin Dwight E, Sung Lillian, Green Michael, Roilides Emmanuel, Belani Kiran, Romero José, Soler-Palacin Pere, López-Medina Eduardo, Nolt Dawn, Bin Hussain Ibrahim Zaid, Muller William J, Hauger Sarmistha B, Halasa Natasha, Dulek Daniel, Pong Alice, Gonzalez Blanca E, Abzug Mark J, Carlesse Fabianne, Huppler Anna R, Rajan Sujatha, Aftandilian Catherine, Ardura Monica I, Chakrabarti Arunaloke, Hanisch Benjamin, Salvatore Christine M, Klingspor Lena, Knackstedt Elizabeth D, Lutsar Irja, Santolaya Maria E, Shuster Sydney, Johnson Sarah K, Steinbach William J, Fisher Brian T
Аннотация
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.