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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 boy with ToF, together with the main risk factors and antifungal therapies. Arrows signify positive Candida parapsilosis isolates from the bloodstream; hash – positive Candida parapsilosis isolate from the pleural drainage; asterisk – telephone information on positive Candida isolates from the bloodstream.
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f2-medscimonit-17-5-ph35: Graph illustrating WBC and CRP levels on consecutive postoperative days for the boy with ToF, together with the main risk factors and antifungal therapies. Arrows signify positive Candida parapsilosis isolates from the bloodstream; hash – positive Candida parapsilosis isolate from the pleural drainage; asterisk – telephone information on positive Candida isolates from the bloodstream.

Mentions: The other patient was an 8-month-old boy (LD) (body weight 6 kg) who was qualified for a corrective surgery of tetralogy of Fallot (ToF) with a critical narrowing of the outflow tract from the right ventricle (RV), with an anomalous course of coronary vessels, hypoplasia of the PA trunk and malalignment ventricular septum defect (VSD) of 15 mm in diameter. Microbiological examinations performed before the surgical procedure excluded Candida colonization. During the surgical correction of the defect with ECC with use of a xenograft (Contegra, USA), we found the thymus to be small and restricted to a single lobe. The early postoperative period was complicated with heart failure and acute renal failure, requiring peritoneal dialysis (3 days). We observed an outflow of dialysis fluid from the pleura despite no iatrogenic communication between the peritoneum and the pleura. On the tenth day after the surgery, despite the use of broad-spectrum antibiotic agents (meropenem, vancomycin) and antifungal prophylaxis (fluconazole), we observed high fever (38.3 degrees Celsius) and deterioration of the general condition of the child. Blood samples from the central venous catheter were cultured; candidemia with Candida parapsilosis isolates was diagnosed (MIC for caspofungin =0.75 mg/L; for fluconazole <1.0 mg/L; for amphotericin B <0.5 mg/L). Fluconazole administration was discontinued and caspofungin was initiated (loading dose of 70 mg/m2, 50 mg/m2 daily thereafter). Positive C. parapsilosis isolates from the pleural drainage were also documented. Blood cultures became negative 20 days after the first positive C. parapsilosis isolates, despite replacement of the central venous catheter. Cultures from the drainage became negative on the fifth day of the antifungal therapy. The total time of caspofungin management reached 34 days (Figure 2). The child was discharged home with no symptoms of heart failure or infection after rehabilitation in our pediatric hospital.


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 boy with ToF, together with the main risk factors and antifungal therapies. Arrows signify positive Candida parapsilosis isolates from the bloodstream; hash – positive Candida parapsilosis isolate from the pleural drainage; 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

f2-medscimonit-17-5-ph35: Graph illustrating WBC and CRP levels on consecutive postoperative days for the boy with ToF, together with the main risk factors and antifungal therapies. Arrows signify positive Candida parapsilosis isolates from the bloodstream; hash – positive Candida parapsilosis isolate from the pleural drainage; asterisk – telephone information on positive Candida isolates from the bloodstream.
Mentions: The other patient was an 8-month-old boy (LD) (body weight 6 kg) who was qualified for a corrective surgery of tetralogy of Fallot (ToF) with a critical narrowing of the outflow tract from the right ventricle (RV), with an anomalous course of coronary vessels, hypoplasia of the PA trunk and malalignment ventricular septum defect (VSD) of 15 mm in diameter. Microbiological examinations performed before the surgical procedure excluded Candida colonization. During the surgical correction of the defect with ECC with use of a xenograft (Contegra, USA), we found the thymus to be small and restricted to a single lobe. The early postoperative period was complicated with heart failure and acute renal failure, requiring peritoneal dialysis (3 days). We observed an outflow of dialysis fluid from the pleura despite no iatrogenic communication between the peritoneum and the pleura. On the tenth day after the surgery, despite the use of broad-spectrum antibiotic agents (meropenem, vancomycin) and antifungal prophylaxis (fluconazole), we observed high fever (38.3 degrees Celsius) and deterioration of the general condition of the child. Blood samples from the central venous catheter were cultured; candidemia with Candida parapsilosis isolates was diagnosed (MIC for caspofungin =0.75 mg/L; for fluconazole <1.0 mg/L; for amphotericin B <0.5 mg/L). Fluconazole administration was discontinued and caspofungin was initiated (loading dose of 70 mg/m2, 50 mg/m2 daily thereafter). Positive C. parapsilosis isolates from the pleural drainage were also documented. Blood cultures became negative 20 days after the first positive C. parapsilosis isolates, despite replacement of the central venous catheter. Cultures from the drainage became negative on the fifth day of the antifungal therapy. The total time of caspofungin management reached 34 days (Figure 2). The child was discharged home with no symptoms of heart failure or infection after rehabilitation in our pediatric hospital.

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