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Candidemia in children after complex congenital heart defects surgery treated with caspofungin--our own experience and a review of literature.

Jaworski R, Irga N, Haponiuk I, Chojnicki M, Arlukowicz E, Steffek M, Sroka M, Gierat-Haponiuk K, Juscinski J, Palkowska L, Sendrowska A, Kosiak W - Med. Sci. Monit. (2011)

Bottom Line: No adverse effects were observed after treatment with the drug.Candidemia in children who undergo surgical treatment of congenital heart defects is an important factor that can influence final clinical results.Caspofungin may be an effective therapeutic option when treating candidemia in children after extensive cardiosurgical procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiac Surgery, Mikołaj Kopernik Pomeranian Centre of Traumatology, Gdansk, Poland. radicis@go2.pl

ABSTRACT

Background: Invasive fungal infections due to Candida species constitute an increasing clinical problem. There are no guidelines for the management of candidemia in children undergoing surgical procedures for congenital heart defects (CHD). The aim of the study was to draw attention to the problem of candidemia in children who are operated on due to congenital heart defects.

Material/methods: We retrospectively analyzed medical documentation of 307 children with congenital heart defects treated in 1 clinical centre in Poland, from whom we selected those diagnosed with candidemia during the postoperative period. Next, we analyzed in detail the clinical course of invasive candidiasis in each individual and we performed an analysis of risk factors that lead to candidemia.

Results: In the analyzed period, among 307 children who underwent surgical procedures, we observed 2 cases of candidemia (0.65%) which were effectively cured with caspofungin. No adverse effects were observed after treatment with the drug.

Conclusions: Candidemia in children who undergo surgical treatment of congenital heart defects is an important factor that can influence final clinical results. Caspofungin may be an effective therapeutic option when treating candidemia in children after extensive cardiosurgical procedures.

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Related in: MedlinePlus

Graph illustrating WBC and CRP levels on consecutive postoperative days for the girl with DORV, together with the main risk factors and antifungal therapies. Arrows signify positive Candida albicans isolates from the bloodstream; asterisk – telephone information on positive Candida isolates from the bloodstream.
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f1-medscimonit-17-5-ph35: Graph illustrating WBC and CRP levels on consecutive postoperative days for the girl with DORV, together with the main risk factors and antifungal therapies. Arrows signify positive Candida albicans isolates from the bloodstream; asterisk – telephone information on positive Candida isolates from the bloodstream.

Mentions: The first patient was a 20-month-old girl (AW) with the diagnosis of a complex congenital heart defect in the form of coarctation of the aorta (CoA) and double-outlet right ventricle (DORV). In the neonatal period the patient underwent a successful surgical procedure of aortic arch repair using the extended end-to-end method, patent ductus arteriosus (PDA) ligation and pulmonary artery banding (PA banding). At the age of 20 months (body weight 9 kg), the performed diagnostic tests confirmed the correct repair of aortic coarctation (with no gradient in the area of previous stenosis) and DORV with non-restrictive non-committed VSD (DORV-nc-VSD) of about 15 mm in diameter. The child was referred for a surgical correction of the defect. Microbiological examinations performed before the surgical procedure confirmed colonization with C. albicans in the nasal cavity. The surgical procedure included DORV correction with Kawashima intraventricular tunnelization with Dacron Savage patch with ECC. After removal of the banding, the pulmonary artery trunk was widened with an autologous pericardial patch. The early postoperative period was complicated with heart failure, therefore support with high doses of catecholamines and delayed sternum closure was necessary. Additionally, the child needed peritoneal dialysis due to acute renal failure (10 days) and total parenteral nutrition (TPN) (16 days). On the eleventh day after the surgery, despite compensation of the cardiovascular system sternum closure, use of antibiotic agents (tazobactam + cefoperazone, vancomycin) and antifungal prophylaxis (fluconazole), the general condition of the girl deteriorated and fever >38.5 degrees Celsius was noted. We observed significantly increased leucocytosis with a left shift (47.3 G/L) and a slight increase of acute-phase reactants (CRP 24 mg/L, normal range <5 mg/L). Blood samples from the central venous catheter were cultured. Two days later, Candida albicans isolates were identified in the blood (minimal inhibitory concentration (MIC) for caspofungin 0.023 mg/L; for fluconazole ≤1 mg/L; for amphotericin B ≤0.25 mg/L). The antifungal management was altered and caspofungin was initiated (loading dose of 70 mg/m2, 50 mg/m2 daily thereafter). Clearance of Candida from the blood was documented and we observed a gradual decrease of leucocytosis. Antifungal therapy was continued for the next 20 days. Over this period, we noted an increase of CRP and leucocytosis. In our opinion, the incident was related to surgical procedures: tracheostomy and percutaneous endoscopic gastrostomy (PEG). After the removal of tracheostomy and PEG (48 days after the surgery) and implementation of intensive rehabilitation, we observed final recovery of the child (Figure 1).


Candidemia in children after complex congenital heart defects surgery treated with caspofungin--our own experience and a review of literature.

Jaworski R, Irga N, Haponiuk I, Chojnicki M, Arlukowicz E, Steffek M, Sroka M, Gierat-Haponiuk K, Juscinski J, Palkowska L, Sendrowska A, Kosiak W - Med. Sci. Monit. (2011)

Graph illustrating WBC and CRP levels on consecutive postoperative days for the girl with DORV, together with the main risk factors and antifungal therapies. Arrows signify positive Candida albicans isolates from the bloodstream; asterisk – telephone information on positive Candida isolates from the bloodstream.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539598&req=5

f1-medscimonit-17-5-ph35: Graph illustrating WBC and CRP levels on consecutive postoperative days for the girl with DORV, together with the main risk factors and antifungal therapies. Arrows signify positive Candida albicans isolates from the bloodstream; asterisk – telephone information on positive Candida isolates from the bloodstream.
Mentions: The first patient was a 20-month-old girl (AW) with the diagnosis of a complex congenital heart defect in the form of coarctation of the aorta (CoA) and double-outlet right ventricle (DORV). In the neonatal period the patient underwent a successful surgical procedure of aortic arch repair using the extended end-to-end method, patent ductus arteriosus (PDA) ligation and pulmonary artery banding (PA banding). At the age of 20 months (body weight 9 kg), the performed diagnostic tests confirmed the correct repair of aortic coarctation (with no gradient in the area of previous stenosis) and DORV with non-restrictive non-committed VSD (DORV-nc-VSD) of about 15 mm in diameter. The child was referred for a surgical correction of the defect. Microbiological examinations performed before the surgical procedure confirmed colonization with C. albicans in the nasal cavity. The surgical procedure included DORV correction with Kawashima intraventricular tunnelization with Dacron Savage patch with ECC. After removal of the banding, the pulmonary artery trunk was widened with an autologous pericardial patch. The early postoperative period was complicated with heart failure, therefore support with high doses of catecholamines and delayed sternum closure was necessary. Additionally, the child needed peritoneal dialysis due to acute renal failure (10 days) and total parenteral nutrition (TPN) (16 days). On the eleventh day after the surgery, despite compensation of the cardiovascular system sternum closure, use of antibiotic agents (tazobactam + cefoperazone, vancomycin) and antifungal prophylaxis (fluconazole), the general condition of the girl deteriorated and fever >38.5 degrees Celsius was noted. We observed significantly increased leucocytosis with a left shift (47.3 G/L) and a slight increase of acute-phase reactants (CRP 24 mg/L, normal range <5 mg/L). Blood samples from the central venous catheter were cultured. Two days later, Candida albicans isolates were identified in the blood (minimal inhibitory concentration (MIC) for caspofungin 0.023 mg/L; for fluconazole ≤1 mg/L; for amphotericin B ≤0.25 mg/L). The antifungal management was altered and caspofungin was initiated (loading dose of 70 mg/m2, 50 mg/m2 daily thereafter). Clearance of Candida from the blood was documented and we observed a gradual decrease of leucocytosis. Antifungal therapy was continued for the next 20 days. Over this period, we noted an increase of CRP and leucocytosis. In our opinion, the incident was related to surgical procedures: tracheostomy and percutaneous endoscopic gastrostomy (PEG). After the removal of tracheostomy and PEG (48 days after the surgery) and implementation of intensive rehabilitation, we observed final recovery of the child (Figure 1).

Bottom Line: No adverse effects were observed after treatment with the drug.Candidemia in children who undergo surgical treatment of congenital heart defects is an important factor that can influence final clinical results.Caspofungin may be an effective therapeutic option when treating candidemia in children after extensive cardiosurgical procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiac Surgery, Mikołaj Kopernik Pomeranian Centre of Traumatology, Gdansk, Poland. radicis@go2.pl

ABSTRACT

Background: Invasive fungal infections due to Candida species constitute an increasing clinical problem. There are no guidelines for the management of candidemia in children undergoing surgical procedures for congenital heart defects (CHD). The aim of the study was to draw attention to the problem of candidemia in children who are operated on due to congenital heart defects.

Material/methods: We retrospectively analyzed medical documentation of 307 children with congenital heart defects treated in 1 clinical centre in Poland, from whom we selected those diagnosed with candidemia during the postoperative period. Next, we analyzed in detail the clinical course of invasive candidiasis in each individual and we performed an analysis of risk factors that lead to candidemia.

Results: In the analyzed period, among 307 children who underwent surgical procedures, we observed 2 cases of candidemia (0.65%) which were effectively cured with caspofungin. No adverse effects were observed after treatment with the drug.

Conclusions: Candidemia in children who undergo surgical treatment of congenital heart defects is an important factor that can influence final clinical results. Caspofungin may be an effective therapeutic option when treating candidemia in children after extensive cardiosurgical procedures.

Show MeSH
Related in: MedlinePlus