CHOP-led research network assesses utility of diagnostic tools and treatment options for pediatric fungal infections
Two recent studies conducted by the International Pediatric Fungal Network, a group co-led by researchers at Children’s Hospital of Philadelphia (CHOP), evaluated a variety of diagnostic tests as well as antifungal treatment options for diagnosis and treatment. initial treatment for invasive candidiasis, a yeast infection that can be fatal for children and adolescents.
Although there are professional guidelines for the treatment of adults with invasive candidiasis, such parameters do not exist for pediatric patients. To improve the initial diagnostic approach and treatment decisions for invasive candidiasis in this population, the research network, co-led by Brian Fisher, DO, MPH, MSCE, attending physician in the Department of Infectious Diseases at CHOP, conducted two separate studies studies.
The first study, published in Clinical Infectious Diseases, focused on improving the time to detection of invasive candidiasis in pediatric patients by evaluating the usefulness of certain fungal biomarkers. Because fungal infections may initially present similarly to bacterial infections, clinicians cannot rely on symptomatic presentation alone and need additional testing to confirm the diagnosis. However, the current standard of care is a blood culture, which can take 24 hours or more to detect infection, delaying initial treatment. New diagnostic fungal biomarkers are approved for the diagnosis of invasive candidiasis in adults, but their use in children and adolescents has not been studied to date.
The research team analyzed the utility of four commercially available fungal biomarkers in pediatric patients aged 4 months to 18 years at risk for invasive candidiasis. Of the four tests, researchers found that T2Candida alone or in combination with Platelia Candida Ag Plus provided the most reliable rapid detection of Candida species in children with invasive candidiasis.
In the second study, published in the Journal of the Pediatric Infectious Diseases Society, researchers compared echinocandins to triazoles or amphotericin B (triazole/amphotericin B) formulations as an initial treatment for invasive candidiasis. Analyzing patients aged 4 months to 18 years at 43 International Pediatric Fungal Network sites, the researchers included 541 study participants who had been diagnosed with invasive candidiasis between 2014 and 2017.
Of these patients, 235 received echinocandin as initial treatment and 306 were in the triazole/amphotericin B group. The researchers found that initial treatment directed with echinocandin was associated with a reduced failure rate at 14 days but not at 30 days, suggesting that echinocandins may be preferable as an initial directed therapy for invasive candidiasis in children and adolescents.
“Together, these studies provide data on the diagnosis and treatment of pediatric patients with invasive candidiasis, which will hopefully lead to evidence-based guidelines specific to children and adolescents,” said Dr. Fisher.
Learn more about the International Pediatric Fungal Network here.