Background: The clinical features and outcome of candidemia in a paediatric population with cardiopathy has never been described before. Methods: All children with congenital cardiopathy admitted to the Hospital between 1988 and 2000 who developed candidemia were selected. Data were obtained retrospectively from clinical records. Results: Fifty-two children were included in the study. The median age of the patients was 2 months and 50% were males. Twenty-nine (56%) had multiple cardiac anomalies. Candidemia occurred after a median stay of 21 days in the ICU and 76% were treated with 3 or more antibiotics being the median time of antibiotic treatment 23 days. Before developing candidemia 48% were colonised by Candida spp. Candidemia was due to C.parapsilosis (28), C.albicans (22), C.glabrata (1) and C. tropicalis (1). The intravenous catheter was removed in 86% and Candida spp. grew from 69% of all cultured catheters. Thirty-eight (73%) patients were treated with antifungal agents for a median time of 15 days (1-93days). Endocarditis due to Candida spp. was diagnosed in 11.5% of cases. The overall mortality was 38.5% and it was attributed to candidemia in 13.5%. The absence of removal of the intravenous catheter, (p=0.05, OR= 6.01; CI 95%: 0.97-37.18) and the higher PRISM (Paediatric Risk of Mortality Index) score (p=0.05, OR=1.44; CI 95%:1.00-1.30) were independently associated to the mortality. Conclusions: Candida bloodstream infections in paediatric patients with cardiopathy do not differ with candidemia in other paediatric patients, but associated endocarditis occurs frequently. Although crude mortality was high, in most cases it was not directly related to the candidemia. The absence of catheter removal and the higher PRISM score were independently associated with the mortality.
Full conference title:
- ICAAC 42nd