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Master of Public Health

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

AUTHORS

Wattier RL , Bucayu RFT , Boge CLK , Ross RK , Yildirim I , Zaoutis TE , Palazzi DL , Vora SB , Castagnola E , Avilés-Robles M , Danziger-Isakov L , Tribble AC , Sharma TS , Arrieta AC , Maron G , Berman DM , Yin DE , Sung L , Green M , Roilides E , Belani K , Romero J , Soler-Palacin P , López-Medina E , Nolt D , Bin Hussain IZ , Muller WJ , Hauger SB , Halasa N , Dulek D , Pong A , Gonzalez BE , Abzug MJ , Carlesse F , Huppler AR , Rajan S , Aftandilian C , Ardura MI , Chakrabarti A , Hanisch B , Salvatore CM , Klingspor L , Knackstedt ED , Lutsar I , Santolaya ME , Shuster S , Johnson SK , Steinbach WJ , Fisher BT , . Journal of the Pediatric Infectious Diseases Society. 2023 8 17; ().

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 -17 years with invasive candidiasis (predominantly candidemia) from 2014-2017. Ophthalmologic examination, abdominal imaging, echocardiogram, neuroimaging, and lumbar puncture were performed per clinician discretion. aDS 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 abdominal imaging, 450 (68%) ophthalmologic examination, 426 (64%) echocardiogram, 160 (24%) neuroimaging, and 76 (11%) lumbar puncture; performance of each aDS per episode varied across sites up to 16-fold. Longer durations of candidemia were associated with undergoing ophthalmologic examination, abdominal imaging, and echocardiogram. Immunocompromised status (58% of episodes) was associated with undergoing abdominal imaging (aOR 2.38; 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 ophthalmologic examination was reported in 15 (3%), abdominal imaging in 30 (6%), echocardiogram in 14 (3%), neuroimaging in 9 (6%) and lumbar puncture 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.

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