Transition to Enteral Triazole Antifungal Therapy for Pediatric Invasive Candidiasis: Secondary Analysis of a Multicenter Cohort Study Conducted by the Pediatric Fungal Network

Robert F T Bucayu^{1

2}, Craig L K Boge², Inci Yildirim^{3

4

5

6}, Martha Avilés-Robles⁷, Surabhi B Vora⁸, David M Berman⁹, Tanvi S Sharma¹⁰, Lillian Sung¹¹, Elio Castagnola¹², Debra L Palazzi¹³, Lara Danziger-Isakov¹⁴, Dwight E Yin¹⁵, Emmanuel Roilides¹⁶, Gabriela Maron¹⁷, Alison C Tribble¹⁸, Pere Soler-Palacin¹⁹, Eduardo López-Medina²⁰, José Romero²¹, Kiran Belani²², Antonio C Arrieta^{23

24}, Fabianne Carlesse²⁵, Dawn Nolt²⁶, Natasha Halasa²⁷, Daniel Dulek²⁷, Sujatha Rajan²⁸, William J Muller²⁹, Monica I Ardura³⁰, Alice Pong³¹, Blanca E Gonzalez³², Christine M Salvatore³³, Anna R Huppler³⁴, Catherine Aftandilian³⁵, Mark J Abzug³⁶, Arunaloke Chakrabarti³⁷, Michael Green³⁸, Irja Lutsar³⁹, Elizabeth D Knackstedt⁴⁰, Sarah K Johnson⁴¹, William J Steinbach⁴¹, Brian T Fisher^{2

42}, Rachel L Wattier¹

Affiliations

¹ Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
² Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³ Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
⁴ Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA.
⁵ Yale Center for Infection and Immunity, Yale University School of Medicine, New Haven, Connecticut, USA.
⁶ Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA.
⁷ Department of Infectious Diseases, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
⁸ Department of Pediatrics, University of Washington and Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington, USA.
⁹ Medical Affairs, Karius, Inc., Redwood City, California, USA.
¹⁰ Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
¹² Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
¹³ Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
¹⁴ Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁵ Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Missouri, USA.
¹⁶ Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University and Hippokration Hospital, Thessaloniki, Greece.
¹⁷ Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
¹⁸ Department of Pediatrics, Division of Pediatric Infectious Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA.
¹⁹ Department of Paediatrics, Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.
²⁰ Centro de Estudios en Infectología Pediátrica, Clínica Imbanaco Grupo Quirónsalud and Universidad del Valle, Cali, Colombia.
²¹ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
²² Pediatric Infectious Diseases, Children's Minnesota, Minneapolis, Minnesota, USA.
²³ Department of Infectious Diseases, Children's Hospital of Orange County, Orange, California, USA.
²⁴ Department of Pediatrics, University of California Irvine, Irvine, California, USA.
²⁵ Instituto de Oncologia Pediatrica-IOP/GRAACC-UNIFESP, São Paulo, Brazil.
²⁶ Division of Pediatric Infectious Diseases, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, Oregon, USA.
²⁷ Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
²⁸ Division of Pediatric Infectious Diseases, Northwell, Cohen Children's Medical Center, New Hyde Park, New York, USA.
²⁹ Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
³⁰ Division of Infectious Diseases and Host Defense Program, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.
³¹ Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, California, USA.
³² Center for Pediatric Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
³³ Division of Pediatric Infectious Diseases, Weill Cornell Medicine and Komansky Children's Hospital, New York, New York, USA.
³⁴ Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA.
³⁵ Division of Pediatric Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
³⁶ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
³⁷ Doodhadhar Burfani Hospital and Research Institute, Haridwar, India.
³⁸ Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pennsylvania, USA.
³⁹ Department of Microbiology, University of Tartu, Tartu, Estonia.
⁴⁰ Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, USA.
⁴¹ Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
⁴² Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

PMID: 39513400
PMCID: PMC12476979
DOI: 10.1093/jpids/piae116

Multicenter Study

Transition to Enteral Triazole Antifungal Therapy for Pediatric Invasive Candidiasis: Secondary Analysis of a Multicenter Cohort Study Conducted by the Pediatric Fungal Network

Robert F T Bucayu et al. J Pediatric Infect Dis Soc. 2024.

. 2024 Dec 30;13(12):633-638.

doi: 10.1093/jpids/piae116.

Authors

Affiliations

¹ Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
² Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³ Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
⁴ Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA.
⁵ Yale Center for Infection and Immunity, Yale University School of Medicine, New Haven, Connecticut, USA.
⁶ Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA.
⁷ Department of Infectious Diseases, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
⁸ Department of Pediatrics, University of Washington and Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington, USA.
⁹ Medical Affairs, Karius, Inc., Redwood City, California, USA.
¹⁰ Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
¹² Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
¹³ Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
¹⁴ Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁵ Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Missouri, USA.
¹⁶ Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University and Hippokration Hospital, Thessaloniki, Greece.
¹⁷ Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
¹⁸ Department of Pediatrics, Division of Pediatric Infectious Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA.
¹⁹ Department of Paediatrics, Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.
²⁰ Centro de Estudios en Infectología Pediátrica, Clínica Imbanaco Grupo Quirónsalud and Universidad del Valle, Cali, Colombia.
²¹ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
²² Pediatric Infectious Diseases, Children's Minnesota, Minneapolis, Minnesota, USA.
²³ Department of Infectious Diseases, Children's Hospital of Orange County, Orange, California, USA.
²⁴ Department of Pediatrics, University of California Irvine, Irvine, California, USA.
²⁵ Instituto de Oncologia Pediatrica-IOP/GRAACC-UNIFESP, São Paulo, Brazil.
²⁶ Division of Pediatric Infectious Diseases, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, Oregon, USA.
²⁷ Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
²⁸ Division of Pediatric Infectious Diseases, Northwell, Cohen Children's Medical Center, New Hyde Park, New York, USA.
²⁹ Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
³⁰ Division of Infectious Diseases and Host Defense Program, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.
³¹ Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, California, USA.
³² Center for Pediatric Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
³³ Division of Pediatric Infectious Diseases, Weill Cornell Medicine and Komansky Children's Hospital, New York, New York, USA.
³⁴ Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA.
³⁵ Division of Pediatric Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
³⁶ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
³⁷ Doodhadhar Burfani Hospital and Research Institute, Haridwar, India.
³⁸ Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pennsylvania, USA.
³⁹ Department of Microbiology, University of Tartu, Tartu, Estonia.
⁴⁰ Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, USA.
⁴¹ Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
⁴² Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

PMID: 39513400
PMCID: PMC12476979
DOI: 10.1093/jpids/piae116

Abstract

Of 319 children with invasive candidiasis, 67 (21%) transitioned from intravenous to enteral antifungal therapy. Eight (12%) transitioned back to intravenous antifungal therapy, one due to perceived treatment failure defined by clinical progression or worsening. Global treatment response at study completion was successful in 66 participants who transitioned to enteral therapy.

Keywords: antifungal agent; candidemia; fluconazole; invasive candidiasis; oral drug administration.

© The Author(s) 2024. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Figures

**Figure 1.**
Swimmer plot showing individual participant trajectories in route of antifungal therapy administration in the enteral antifungal transition group. Each bar represents a single participant, numbers on Y-axis represent rank order from earliest to latest transition. The X-axis represents follow-up time from day 0, the day of qualifying culture collection, to day 30. Darker bar components represent time on intravenous antifungal therapy, and lighter bar components represent time on exclusively enteral antifungal therapy. Dashed lines represent ongoing study follow-up without antifungal therapy administered. The open diamond represents an episode with a global response to failure.

See this image and copyright information in PMC

References

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Transition to Enteral Triazole Antifungal Therapy for Pediatric Invasive Candidiasis: Secondary Analysis of a Multicenter Cohort Study Conducted by the Pediatric Fungal Network

Affiliations

Transition to Enteral Triazole Antifungal Therapy for Pediatric Invasive Candidiasis: Secondary Analysis of a Multicenter Cohort Study Conducted by the Pediatric Fungal Network

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