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Analysis of Independent Risk Factors for Death Among Pediatric Patients With Candidemia and a Central Venous Catheter in Place

Published online by Cambridge University Press:  02 January 2015

Alessandro C. Pasqualotto ,
Anaelena B. de Moraes ,
Roselaine R. Zanini  and
Luiz Carlos Severo
Alessandro C. Pasqualotto*
Affiliation:
Department of Infection Control, Santa Casa Complexo Hospitalar, School of Medicine, University of Manchester, United Kingdom
Anaelena B. de Moraes
Affiliation:
Programa de Pôs-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, United Kingdom
Roselaine R. Zanini
Affiliation:
Programa de Pôs-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, United Kingdom
Luiz Carlos Severo
Affiliation:
Mycology Laboratory, Santa Casa Complexo Hospitalar, Porto Alegre, RS, Brazil
*
1/512 Wilmslow Road, Manchester, M20 4BT, United Kingdom (acpasqualotto@hotmail.com)
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Abstract

Objective.

To use multivariate analysis to determine risk factors for death among pediatric patients with candidemia and a central venous catheter in place.

Design.

Retrospective cohort study conducted at Santa Casa Complexo Hospitalar, a 1,200-bed teaching hospital in southern Brazil.

Methods.

All cases of candidemia in pediatric patients (age, ≤ 13 years) at our medical center over a 9-year period were reviewed. A diagnosis of sepsis was required for inclusion in the study. Severity of illness was confirmed by the presence of hypotension requiring inotropes and according to the following scores: the Pediatric Risk of Mortality (PRISM) II score, the PRISM III score, and the Pediatric Logistic Organic Dysfunction score. The following 2 outcomes were evaluated: early death, defined as death occurring within 7 days after candidemia was diagnosed, and late death, defined as death 8-30 days after candidemia was diagnosed.

Results.

A total of 61 patients were included in the study, including 14 neonates. Most (63.9%) of these patients were girls, and the median age was 0.3 years. A total of 80.3% of candidemia cases were due to species other than Candida albicans, primarily Candida parapsilosis (32.8% of cases) and Candida tropicalis (24.6% of cases). Using multivariate analysis, we demonstrated that failure to remove the central venous catheter was an independent risk factor for early death among pediatric patients with candidemia. However, patients whose catheters were retained were sicker than patients whose catheters were removed, and catheter removal had no impact on late death. Instead, severity of illness determined using the PRISM III score was also an independent predictor of late death.

Conclusions.

Results from this study suggest that systematic removal of catheters from pediatric patients with candidemia does not reduce the occurrence of late death.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 799 - 804
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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