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Risk Factors for Candidemia in Pediatric Patients With Congenital Heart Disease

Published online by Cambridge University Press:  21 June 2016

Lucía García-San Miguel ,
Javier Cobo ,
Isabel Martos ,
Enrique Otheo ,
Alfonso Muriel ,
Vicente Pintado  and
Santiago Moreno
Lucía García-San Miguel*
Affiliation:
Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
Javier Cobo
Affiliation:
Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
Isabel Martos
Affiliation:
Pediatric Intensive Care Unit, Ramón y Cajal Hospital, Madrid, Spain
Enrique Otheo
Affiliation:
Pediatric Intensive Care Unit, Ramón y Cajal Hospital, Madrid, Spain
Alfonso Muriel
Affiliation:
Biostatistics Unit, Ramón y Cajal Hospital, Madrid, Spain
Vicente Pintado
Affiliation:
Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
Santiago Moreno
Affiliation:
Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
*
Hospital Ramón y Cajal, Servicio de Enfermedades Infecciosas, Carretera de Colmenar Km 9,100, Madrid 28034, Spain (lgarcias.hrc@salud.madrid.org)
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Abstract

Objective.

To identify the main risk factors for the acquisition of candidemia in children with congenital heart disease (CHD) in order to improve the clinical management of these patients.

Design.

A case-control study.

Setting.

A large tertiary-care referral center in Spain with a pediatric intensive care unit (PICU) to which more than 500 children with CHD are admitted annually.

Patients.

All patients had CHD and were admitted to the PICU during 1995-2000. Case patients were defined as patients with candidemia, and control patients were defined as patients without candidemia.

Results.

Twenty-eight case patients and 47 control subjects were included in the study. Case patients were younger (mean age [ ± SD], 12.5 ± 32.0 vs 38.0 ± 48.0 months; P< .01) and had a longer median PICU stay (19 vs 4 days; P < .01), and a greater percentage of case patients previously had Candida species isolated from specimens other than blood (eg, bronchial aspirates, urine, or skin specimens) (39% vs 4%; P<.01). Severity of clinical condition, as measured by the Therapeutic Intervention Scoring System (TISS) 1 week after PICU admission (odds ratio, 1.15; 95% confidence interval, 1.05-1.26; P<.01), and receipt of antibiotic treatment for more than 5 days (odds ratio, 13.42; 95% confidence interval, 1.31-137.13; P = .03) were independently associated with the development of candidemia.

Conclusions.

Patients with CHD who have a high TISS score 1 week after PICU admission and patients who have received prolonged antibiotic therapy should be considered at high risk for candidemia. Our results suggest that shorter courses of antibiotic therapy, routine surveillance culture for Candida species, and initiation of preemptive or empirical antifungal treatment could help in the clinical management of these patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 6 , June 2006 , pp. 576 - 580
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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