{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T22:35:31Z","timestamp":1788474931220,"version":"build-2803163510"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:00:00Z","timestamp":1692230400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["5R01AI103315"],"award-info":[{"award-number":["5R01AI103315"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Adjunctive diagnostic studies (aDS) are recommended to identify occult dissemination in patients with candidemia. Patterns of evaluation with aDS across pediatric settings are unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u20133.74). Intensive care at candidemia onset (30% of episodes) was associated with undergoing echocardiogram (aOR 2.42; 95% CI 1.51\u20133.88). 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%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piad057","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T12:54:52Z","timestamp":1692276892000},"page":"487-495","source":"Crossref","is-referenced-by-count":7,"title":["Adjunctive Diagnostic Studies Completed Following Detection of Candidemia in Children: Secondary Analysis of Observed Practice From a Multicenter Cohort Study Conducted by the Pediatric Fungal Network"],"prefix":"10.1093","volume":"12","author":[{"given":"Rachel L","family":"Wattier","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of California San Francisco , San Francisco, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F T","family":"Bucayu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California San Francisco , San Francisco, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig L K","family":"Boge","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Philadelphia , Philadelphia, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael K","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of North Carolina Chapel Hill , Chapel Hill, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inci","family":"Yildirim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yale University School of Medicine , Connecticut , USA"},{"name":"Yale Institute for Global Health, Yale University , New Haven, Connecticut , USA"},{"name":"Yale Center for Infection and Immunity , New Haven, Connecticut , USA"},{"name":"Department of Epidemiology, Yale School of Public Health , New Haven, Connecticut , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theoklis E","family":"Zaoutis","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Philadelphia , Philadelphia, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra L","family":"Palazzi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Baylor College of Medicine and Texas Children\u2019s Hospital , Houston, Texas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surabhi B","family":"Vora","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington, Division of Infectious Diseases, Seattle Children\u2019s Hospital , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elio","family":"Castagnola","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, IRCCS Istituto Giannina Gaslini , Genoa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Avil\u00e9s-Robles","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital Infantil de M\u00e9xico Federico G\u00f3mez , Mexico City , Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Danziger-Isakov","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, University of Cincinnati , Cincinnati, Ohio , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison C","family":"Tribble","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Michigan and C.S. Mott Children\u2019s Hospital , Ann Arbor, Michigan , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanvi S","family":"Sharma","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Boston Children\u2019s Hospital, Harvard Medical School , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio C","family":"Arrieta","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Orange County , Orange, California , USA"},{"name":"Department of Pediatrics, University of California Irvine , Irvine, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Maron","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, St. Jude Children\u2019s Research Hospital , Memphis, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Berman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Johns Hopkins All Children\u2019s Hospital , St. Petersburg, Florida , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8599-1004","authenticated-orcid":false,"given":"Dwight E","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Mercy and University of Missouri-Kansas City School of Medicine , Kansas City, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillian","family":"Sung","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology, The Hospital for Sick Children , Toronto , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Pittsburgh of UPMC , Pittsburgh, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0202-364X","authenticated-orcid":false,"given":"Emmanuel","family":"Roilides","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University and Hippokration Hospital , Thessaloniki , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Belani","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases, Children\u2019s Minnesota , Minneapolis, Minnesota , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Romero","sequence":"additional","affiliation":[{"name":"National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0346-5570","authenticated-orcid":false,"given":"Pere","family":"Soler-Palacin","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d\u2019Hebron , Barcelona, Catalonia , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3066-5938","authenticated-orcid":false,"given":"Eduardo","family":"L\u00f3pez-Medina","sequence":"additional","affiliation":[{"name":"Centro de Estudios en Infectolog\u00eda Pedi\u00e1trica, Cl\u00ednica Imbanaco Grupo Quir\u00f3nsalud and Universidad del Valle , Cali , Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Nolt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oregon Health and Science University and Doernbecher Children\u2019s Hospital , Portland, Oregon , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim Zaid","family":"Bin Hussain","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Center , Riyadh , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J","family":"Muller","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago and Northwestern University Feinberg School of Medicine , Chicago, Illinois , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarmistha B","family":"Hauger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas at Austin and Dell Children\u2019s Medical Center , Austin, Texas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Halasa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt , Nashville, Tennessee , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Dulek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt , Nashville, Tennessee , 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