Invasive fungal infections in critically ill children: epidemiology, risk factors and antifungal drugs.

Autor:	Hon KLE; Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China.; Department of Paediatrics, CUHKMC, The Chinese University of Hong Kong, Hong Kong, China., Chan VP; Department of Pharmacy, Hong Kong Children's Hospital, Hong Kong, China., Leung AK; Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada., Leung KKY; Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China., Hui WF; Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China.
Jazyk:	angličtina
Zdroj:	Drugs in context [Drugs Context] 2024 Jun 17; Vol. 13. Date of Electronic Publication: 2024 Jun 17 (Print Publication: 2024).
DOI:	10.7573/dic.2023-9-2
Abstrakt:	Background: Invasive fungal infections (IFIs) are important infectious complications amongst critically ill children. The most common fungal infections are due to Candida species. Aspergillus , Zygomycetes and Fusarium are also emerging because of the empirical use of antifungal drugs. This updated review discusses the epidemiology of IFIs as well as antifungal drugs, dosing and potential adverse effects in critically ill children. Methods: A PubMed search was conducted with Clinical Queries using the key terms "antifungal", "children", "critical care" AND "paediatric intensive care unit" OR "PICU". The search strategy included clinical trials, randomized controlled trials, meta-analyses, observational studies and reviews and was limited to the English literature in paediatrics. Results: Candida and Aspergillus spp. are the most prevalent fungi in paediatric IFIs, causing invasive candidiasis infections (ICIs) and invasive aspergillosis infections (IAIs), respectively. These IFIs are associated with high morbidity, mortality and healthcare costs. Candida albicans is the principal Candida spp. associated with paediatric ICIs. The risks and epidemiology for IFIs vary if considering previously healthy children treated in the paediatric intensive care unit or children with leukaemia, malignancy or a severe haematological disease. The mortality rate for IAIs in children is 2.5-3.5-fold higher than for ICIs. Four major classes of antifungals for critically ill children are azoles, polyenes, antifungal antimetabolites and echinocandins. Conclusions: Antifungal agents are highly efficacious. For successful treatment outcomes, it is crucial to determine the optimal dosage, monitor pharmacokinetics parameters and adverse effects, and individualized therapeutic monitoring. Despite potent antifungal medications, ICIs and IAIs continue to be serious infections with high mortality rates. Pre-emptive therapy has been used for IAIs. Most guidelines recommend voriconazole as initial therapy of invasive aspergillosis in most patients, with consideration of combination therapy with voriconazole plus an echinocandin in selected patients with severe disease. The challenge is to identify critically ill patients at high risks of ICIs for targeted prophylaxis. Intravenous/per os fluconazole is first-line pre-emptive treatment for Candida spp. whereas intravenous micafungin or intravenous liposomal amphotericin B is alternative pre-emptive treatment.This article is part of the Challenges and strategies in the management of invasive fungal infections Special Issue: https://www.drugsincontext.com/special_issues/challenges-and-strategies-in-the-management-of-invasive-fungal-infections. Competing Interests: Disclosure and potential conflicts of interest: Professor Kam Lun Hon and Professor Alexander KC Leung are associate editors of Drugs in Context. The authors declare that there is no conflict of interest otherwise. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2024/04/dic.2023-9-2-COI.pdf (Copyright © 2024 Hon KLE, Chan VPY, Leung AKC, Leung KKY, Hui WF.)
Databáze:	MEDLINE
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