Candidemia in a pediatric intensive care unit.
OBJECTIVE
To examine the incidence, epidemiology, and clinical characteristics of candidemia in a pediatric intensive care unit.


METHODS
Retrospective cohort study.


METHODS
Pediatric intensive care unit of a tertiary care teaching and referral hospital in north India.


METHODS
All patients with candidemia from March 1993 to December 1996.


METHODS
Patient-related data were analyzed to study candidemia in relation to reason for fungal culture, underlying medical conditions, predisposing factors, Candida isolates, antimicrobial and antifungal treatment, and deaths.


RESULTS
Sixty-four patients with candidemia were identified. The Candida species isolated were Candida tropicalis (48.4%), C. albicans (29.7%), C. guillermondii (14.1%), C. krusei (6.3%), and C. glabrata (1.6%). Thirty-three patients were detected by a high-risk surveillance blood culture, whereas 31 patients were detected while undergoing septic workup. Sixteen (25%) patients were asymptomatic; they recovered without any antifungal therapy and without any sequelae. Of 48 symptomatic patients, 11 died before institution of antifungal therapy; 37 received oral itraconazole (10 mg.kg(-1).day(-1)). Seven (19%) of these 37 patients died. Those who recovered had sterile culture on average by day 14 (range, 4-30) and received the antifungal therapy on average for 24 days (range, 9-42 days). Overall mortality rate was 28.1%, and bivariate analysis showed significant association with Pediatric Risk of Mortality score (p =.0001), presence of symptoms (p =.003), isolation of nonalbicans Candida in general (p =.04) and C. tropicalis specifically (p =.001), and failure to give presumptive antifungal therapy (p =.055). On multivariate analysis, Pediatric Risk of Mortality score and isolation of C. tropicalis were the only significant predictors of mortality.


CONCLUSIONS
Nonalbicans Candida accounted for 70% of candidemia in a pediatric intensive care unit. High-risk surveillance blood cultures aided diagnosis in about half the patients. Severity of illness and isolation of C. tropicalis were significant predictors of mortality.
Singhi
Sunit C
SC
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Reddy
Thimmapuram C S
TC
Chakrabarti
Arunloke
A
D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D018709:Statistics, Nonparametric