Risk factors and predictors for candidemia in pediatric intensive care unit patients: implications for prevention.
BACKGROUND
Candida species are the leading cause of invasive fungal infections in hospitalized children and are the third most common isolates recovered from patients with healthcare-associated bloodstream infection in the United States. Few data exist on risk factors for candidemia in pediatric intensive care unit (PICU) patients.


METHODS
We conducted a population-based case-control study of PICU patients at Children's Hospital of Philadelphia during the period from 1997 through 2004. Case patients were identified using laboratory records, and control patients were selected from PICU rosters. Control patients were matched to case patients by incidence density sampling, adjusting for time at risk. Following conditional multivariate analysis, we performed weighted multivariate analysis to determine predicted probabilities for candidemia given certain risk factor combinations.


RESULTS
We identified 101 case patients with candidemia (incidence, 3.5 cases per 1000 PICU admissions). Factors independently associated with candidemia included presence of a central venous catheter (odds ratio [OR], 30.4; 95% confidence interval [CI], 7.7-119.5), malignancy (OR, 4.0; 95% CI, 1.23-13.1), use of vancomycin for >3 days in the prior 2 weeks (OR, 6.2; 95% CI, 2.4-16), and receipt of agents with activity against anaerobic organisms for >3 days in the prior 2 weeks (OR, 3.5; 95% CI, 1.5-8.4). Predicted probability of having various combinations of the aforementioned factors ranged from 10.7% to 46%. The 30-day mortality rate was 44% among case patients and 14% among control patients (OR, 4.22; 95% CI, 2.35-7.60).


CONCLUSIONS
To our knowledge, this is the first study to evaluate independent risk factors and to determine a population of children in PICUs at high risk for developing candidemia. Future efforts should focus on validation of these risk factors identified in a different PICU population and development of interventions for prevention of candidemia in critically ill children.
Zaoutis
Theoklis E
TE
Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. Zaoutis@email.chop.edu
Prasad
Priya A
PA
Localio
A Russell
AR
Coffin
Susan E
SE
Bell
Louis M
LM
Walsh
Thomas J
TJ
Gross
Robert
R
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D016469:Fungemia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009369:Neoplasms / Q000150:complications; D016017:Odds Ratio; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D014640:Vancomycin