Diagnosis and Management of Fungal Infections in the Pediatric Intensive Care Unit

Abstract

Invasive fungal disease contributes significantly to morbidity and mortality in the hospitalized pediatric patient. Intensive care unit patients, secondary to both their underlying illness and exposure to known risk factors, represent a high-risk group. Significant diagnostic limitations make early detection and treatment initiation difficult, with treatment delays associated with worse outcomes. Early detection therefore requires clinicians to maintain a high index of suspicion. While the use of biomarkers and fungal PCR represent a promising avenue for earlier diagnosis, most tests have not yet been validated in pediatric patients. Until then, the clinician should limit testing to those patients with known risk factors and interpret results within the larger clinical picture. Empiric therapy with respect to invasive candidiasis should be restricted to patients with known risk factors and a sepsis-like picture who fail to respond to broad-spectrum antibiotic therapy within a 72-h time frame, noting again that this is not a standardized guideline. Clinicians must be mindful of pharmacokinetic variation and dosing variability when implementing treatment in the pediatric population.