Risk Factors for Mortality in Children with Candidemia

THEOKLIS E. ZAOUTIS, MD1, SUSAN E. COFFIN, MD, MPH1, JACLYN H. CHU, MHS1, MOLLIE GREVES, MD2, THOMAS J. WALSH,

Author address: 

1The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, 2University of Washington School of Medicine, Seattle,

Abstract: 

Background: Candidemia is a frequent and potentially life-threatening complication for many chronically and critically ill children. There are limited pediatric data regarding risk factors for mortality, and findings in adults may not be relevant. This study was performed to determine the demographic, clinical, and catheter-related risk factors for mortality among children with candidemia. Methods: We conducted a retrospective cohort study of patients at The Children’s Hospital of Philadelphia, an urban, academic, tertiary care children’s hospital. All subjects were identified by the presence of a positive blood culture for Candida during 1998 to 2001. Data on demographics, comorbidities, antimicrobial use, catheter-related interventions, and other clinical procedures were collected. The outcome was defined as in-hospital mortality within one month of infection. Results: There were 159 episodes of candidemia among 140 eligible patients. The median age was 4.1 years (IQR: 1.0, 14.5). Forty-two percent were in an ICU at time of infection, and 64% received an amphotericin B formulation exclusively during the course of treatment. Candida albicans was the most prevalent infecting isolate and accounted for 41% of cases, followed by C. parapsilosis with 24%, and C. glabrata with 12%. Catheter removal and replacement were not significant predictors on univariate analysis. The statistically significant predictors for mortality on multivariate analysis were location in the PICU (OR=63.2, 95% CI: 7.8, 513.9), NICU (OR=22.1, 95% CI: 2.0, 244.1), and neutropenia within 2 weeks prior to infection (OR=17.9, 95% CI: 2.0, 159.0). Conclusion: The development of candidemia in an ICU and the presence of neutropenia were strong independent risk factors for mortality in this study, suggesting that factors related to increased severity of illness are the most important predictors of death. These findings also demonstrate that removal of a central line in children with candidemia does not improve the probability of survival, which is consistent with current data implicating the gastrointestinal tract rather than percutaneous exposure through catheters as the primary source for invasive Candida infections.
2004

abstract No: 

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Full conference title: 

42nd Annual Meeting Infectious Diseases Society of America
    • Infectious Diseases Society of America 42nd