BACKGROUND Adjunctive diagnostic studies (aDS) are recommended to identify occult dissemination in patients with candidemia. Patterns of evaluation with aDS across pediatric settings are unknown. METHODS Candidemia episodes were included in a secondary analysis of a multicenter comparative effectiveness study that prospectively enrolled participants age 120 days to 17 years with invasive candidiasis (predominantly candidemia) from 2014 to 2017. Ophthalmologic examination (OE), abdominal imaging (AbdImg), echocardiogram, neuroimaging, and lumbar puncture (LP) were performed per clinician discretion. Adjunctive diagnostic studies performance and positive results were determined per episode, within 30 days from candidemia onset. Associations of aDS performance with episode characteristics were evaluated via mixed-effects logistic regression. RESULTS In 662 pediatric candidemia episodes, 490 (74%) underwent AbdImg, 450 (68%) OE, 426 (64%) echocardiogram, 160 (24%) neuroimaging, and 76 (11%) LP; performance of each aDS per episode varied across sites up to 16-fold. Longer durations of candidemia were associated with undergoing OE, AbdImg, and echocardiogram. Immunocompromised status (58% of episodes) was associated with undergoing AbdImg (adjusted odds ratio [aOR] 2.38; 95% confidence intervals [95% CI] 1.51-3.74). Intensive care at candidemia onset (30% of episodes) was associated with undergoing echocardiogram (aOR 2.42; 95% CI 1.51-3.88). Among evaluated episodes, positive OE was reported in 15 (3%), AbdImg in 30 (6%), echocardiogram in 14 (3%), neuroimaging in 9 (6%), and LP in 3 (4%). CONCLUSIONS Our findings show heterogeneity in practice, with some clinicians performing aDS selectively, potentially influenced by clinical factors. The low frequency of positive results suggests that targeted application of aDS is warranted.

中文翻译：

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检测儿童念珠菌血症后完成的辅助诊断研究：对儿科真菌网络进行的多中心队列研究中观察到的实践进行二次分析。

背景 建议进行辅助诊断研究（aDS）来识别念珠菌血症患者的隐匿性传播。儿科环境中 aDS 的评估模式尚不清楚。方法 念珠菌血症发作被纳入一项多中心比较有效性研究的二次分析中，该研究前瞻性招募了 2014 年至 2017 年年龄为 120 天至 17 岁的侵袭性念珠菌病（主要是念珠菌血症）参与者。眼科检查 (OE)、腹部影像学 (AbdImg)、超声心动图根据临床医生的判断进行神经影像学检查和腰椎穿刺 (LP)。辅助诊断研究的表现和阳性结果是在念珠菌血症发作后 30 天内每次发作时确定的。通过混合效应逻辑回归评估 aDS 表现与发作特征的关联。结果 在 662 例儿童念珠菌血症发作中，490 例 (74%) 例接受了 AbdImg，450 例 (68%) 例进行了 OE，426 例 (64%) 例进行了超声心动图检查，160 例 (24%) 例进行了神经影像检查，76 例 (11%) 例进行了 LP；每集每个 ADS 的性能在不同站点之间差异高达 16 倍。较长的念珠菌血症持续时间与接受 OE、AbdImg 和超声心动图相关。免疫功能低下状态（58% 的发作）与接受 AbdImg 相关（调整后的比值比 [aOR] 2.38；95% 置信区间 [95% CI] 1.51-3.74）。念珠菌血症发作时的重症监护（占发作的 30%）与超声心动图检查相关（aOR 2.42；95% CI 1.51-3.88）。在评估的发作中，报告阳性 OE 为 15 例 (3%)，AbdImg 为 30 例 (6%)，超声心动图为 14 例 (3%)，神经影像为 9 例 (6%)，LP 为 3 例 (4%)。结论 我们的研究结果显示实践中存在异质性，一些临床医生选择性地执行 aDS，可能受到临床因素的影响。阳性结果频率较低表明有必要有针对性地应用 aDS。