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Table 3 Clinical features, treatment and outcomes of invasive candidiasis in neonatal episodes versus non-neonatal pediatric episodes

From: Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates

  Neonatal episodes (total n = 113) Non-neonatal pediatric episodes (total n = 229) P value
Clinical features
 Severe sepsis 55 (48.7) 71 (31.0) 0.002
 Septic shock 39 (34.5) 50 (21.8) 0.013
 Progressive and deteriorated candidiasisa 27 (23.9) 34 (14.8) 0.050
 Disseminated candidiasisb 5 (4.4) 9 (3.9) 0.828
Breakthrough invasive candidiasis 10 (8.8) 31 (13.5) 0.288
Duration of candidemia and/or persistent invasive fungal infection
 Days, median (interquartile range) 3.0 (1.0–6.0) 1.0 (1.0–5.0) 0.033
 ≤2 days 48 (42.5) 131 (57.2)  
 3–7 days 46 (40.7) 59 (25.8)  
 ≥8 days 19 (16.8) 39 (17.0)  
Antifungal regimens for treatment    <  0.001
 Fluconazole/Voriconazole 34 (30.1) 97 (42.4)  
 Amphotericin B 50 (44.2) 47 (20.5)  
 Echinocandin 20 (17.7) 76 (33.2)  
 Combination antifungal treatment 6 (5.3) 2 (0.9)  
 None 3 (2.7) 7 (3.1)  
Antifungal treatment within 24 h 36 (31.8) 105 (45.9) 0.014
Duration between onset of invasive candidiasis and initiation of antifungal agents, mean ± SD (days) 2.1 ± 1.3 1.7 ± 1.4 0.009
Total treatment duration (days), mean (range) 17.5 (2.0–46.0) 18.9 (1.0–68.0) 0.113
Removal of central venous catheter within 3 days of onset 34/108 (31.5) 73/214 (34.1) 0.622
Treatment outcomes
 Responsiveness after initiation of antifungal treatmentc    0.157
  Within 72 h 39 (34.5) 96 (41.9)  
  4–7 days 17 (15.0) 47 (20.5)  
  More than 7 days 21 (18.6) 41 (17.9)  
  Treatment failure 36 (31.0) 45 (19.7) 0.015
 Modification of antifungal treatment 44 (38.9) 107 (46.7) 0.203
 Invasive candidiasis attributable mortality 32 (28.3) 40 (17.5) 0.024
 In-hospital all-cause mortality 41/96 (42.7) 47/185 (25.4) 0.004
  1. All data were expressed as number (percentage %), unless indicated otherwise
  2. aDefined as candidemia episodes with more disseminated candidiasis and/or progressive multi-organ failure even after effective antifungal agents
  3. bIndicated positive Candida isolates recovered from more than two sterile sites, in addition to primary bloodstream infection
  4. cResponsiveness was defined according to the consensus criteria of the Mycoses Study Group and European Organization for Research and Treatment of Cancer [29]