Among pediatric fungal infections, invasive candidiasis is a common and frequently fatal infection in high-risk hospitalized children. Invasive candidiasis is of particular concern in immunocompromised children often resulting in significant morbidity and mortality. It is a yeast infection that can disseminate to any part of the body.  CPCE's pediatric fungal infections research is addressing important questions about the frequency, risk factors, diagnosis, and best treatment strategies for children with this infection.

Diagnosis and Treatment of Invasive Fungal Infections

Coordinated efforts have improved the prevention and treatment of fungal infections such as invasive candidiasis in adult patients, but little work has been done to improve outcomes in children. As a result, practice guidelines addressing the treatment for invasive candidiasis contain limited and poorly validated data for children. This lack of pediatric-specific information is concerning as major differences exist between the two populations.

CPCE researchers are addressing the important pediatric gaps in knowledge specifically working to establish the incidence, identify risk factors, improve diagnostic capabilities, and identify best treatment strategies for children with this infection. We have established a worldwide network of children’s hospitals called the International Pediatric Fungal Network (IPFN) to collect data about children diagnosed with invasive candidiasis, as well as those at high risk for developing candidiasis.

The following NIH funded prospective observational cohorts have been initiated within the IPFN:

PEACE: Pediatric Antifungal Comparative Effectiveness

The primary objective of this project is to compare the effectiveness of echinocandin versus amphotericin B or triazole antifungal therapies for pediatric invasive candidiasis. We also seek to characterize the frequency of invasive candidiasis in pediatric patients. Optimal antifungal therapy for children is currently unknown. Thus, our overarching objective is to develop new evidence-based treatment guidelines for invasive candidiasis in children.

This project plans to enroll new patients through the end of 2017.

Funding: National Institute of Allergy and Infectious Diseases

BIOPIC: Fungal Biomarkers for Diagnosis and Response to Therapy for Pediatric Candidemia

This study will determine if novel fungal biomarkers can improve the time to diagnosis of invasive candidiasis in high risk pediatric patients as compared to traditional blood cultures.  Additionally, these same fungal biomarkers will be evaluated to measure response to antifungal treatment in those high risk patients that develop invasive candidiasis. 

This study plans to prospectively enroll 500 patients throughout the IPFN sites from 2015-2018. Using findings from previous epidemiologic studies of patients with invasive candidiasis, we will enroll pediatric patients who are deemed “high risk” for developing invasive candidiasis. These patients will be followed over fourteen days and if positive, will provide additional blood samples.

The purpose of this study is to define the operating characteristics, including sensitivity, specificity, positive predictive value, and negative predictive value, of fungal biomarker assays in pediatric patients at high risk for IC. We also seek to determine the change in fungal biomarker assay results in children who are positive for IC, and create a biobank of blood samples from high risk patients for future work. 

Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

See previous IPFN research studies and publications here. 

Please contact Brian Fisher, DO, MSCE for more information about this line of research.