title: Risk factors for systemic Candida infections in pediatric small bowel transplant recipients.
abstract: BACKGROUND
  Fungal infections are an important cause of morbidity and mortality after small bowel transplantation (SBT). Little information about risk factors for Candida infections in pediatric SBT is available.
  
  
  METHODS
  We performed a 1:1 matched retrospective case-control study including 23 Candida culture-positive patients (cases) and 23 culture-negative patients (controls), matched based on age and time of transplantation. Patients' characteristics were compared using Wilcoxon rank-sum, χ, or Fisher exact tests. McNemar test was used to assess discordance between pretransplant and posttransplant fungemia. Univariate and multivariable conditional logistic regression analyses were performed to identify risk factors.
  
  
  RESULTS
  The median age of the group was 1.87 years (range, 0.87-17.60); 59% patients were male. Within 1 month before transplant, 8.7% cases had fungemia and within 1-6 months before transplant, 30.4% cases had fungemia, compared with 69.6% within the 12 months after transplantation (P = 0.0001 and P = 0.02). By univariate analysis, total parenteral nutrition (TPN) (odds ratio [OR], 17.0 [95% confidence interval: 2.12, 2198]; P = 0.003) and antibiotic administration (OR, 18.99 [2.42, 2449]; P = 0.002) were risk factors for fungal infections. By multivariable analysis, both remained independent risk factors (TPN: OR, 10.86 [1.23, 1425], P = 0.03; antibiotic administration: OR, 12.83 [1.52, 1672], P = 0.01).
  
  
  CONCLUSIONS
  Fungemia was significantly more frequent after SBT than before transplantation. Patients receiving TPN and antibiotic treatment had, respectively, 11 and 13 times higher risk of developing Candida infections after SBT.
authors.affiliation: Division of Infectious Diseases, Transplant Infectious Diseases Program, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198–5400, USA. dflorescu@unmc.edu
authors.forename: Diana F
authors.initials: DF
authors.lastname: Florescu
authors.forename: Fang
authors.initials: F
authors.lastname: Qiu
authors.forename: David F
authors.initials: DF
authors.lastname: Mercer
authors.forename: Alan N
authors.initials: AN
authors.lastname: Langnas
authors.forename: Laura R
authors.initials: LR
authors.lastname: Shafer
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D002177:Candidiasis / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007410:Intestinal Diseases / Q000601:surgery*; D007421:Intestine, Small; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014180:Transplantation
chemical_list: D000900:Anti-Bacterial Agents