title: Fungal infections and antifungal prophylaxis in pediatric cardiac extracorporeal life support.
abstract: OBJECTIVE
  Infections acquired by children during extracorporeal membrane oxygenation (ECMO) increase mortality. Our aim was to evaluate the effectiveness of prophylactic fluconazole on the incidence of fungal infections and to assess whether hospital-acquired fungal infection is associated with increased in-hospital mortality in pediatric cardiac patients requiring ECMO.
  
  
  METHODS
  We retrospectively reviewed a prospectively maintained database and collected data on all hospital-acquired infections in patients supported for cardiac indications at a tertiary children's hospital from 1989 to 2008.
  
  
  RESULTS
  ECMO was deployed 801 times in 767 patients. After exclusion criteria were applied, 261 pediatric patients supported for cardiac indications were studied. Fungal infection (blood, urine, or surgical site) occurred in 12% (31/261) of patients, 9 (7%) of 127 patients receiving fluconazole prophylaxis versus 22 (16.4%) of 134 without antifungal prophylaxis (P = .02). Using a multivariable logistic regression model, the absence of fluconazole prophylaxis was associated with an increased risk of fungal infection (odds ratio [OR] = 2.8; 95% confidence intervals [CI], 1.2, 6.7; P = .016). In a multivariable logistic regression model for in-hospital mortality, the presence of fungal infection was associated with increased odds (OR = 3.8; 95% CI, 1.5, 9.6; P = .005) of in-hospital mortality among cardiac patients requiring ECMO, and the absence of antifungal prophylaxis showed a trend toward the same (OR = 1.6; 95% CI, 0.96, 2.8; P = .072).
  
  
  CONCLUSIONS
  Children with cardiac disease supported with ECMO who acquire fungal infections have increased mortality. Routine fluconazole prophylaxis is associated with lower rates of fungal infections in these patients.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR 72202-3591, USA.
authors.forename: Aaron H
authors.initials: AH
authors.lastname: Gardner
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Stovall
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Gossett
authors.forename: Jennie E
authors.initials: JE
authors.lastname: Stern
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Wilson
authors.forename: Richard T
authors.initials: RT
authors.lastname: Fiser
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage*; D001131:Arkansas; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D004334:Drug Administration Schedule; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009181:Mycoses / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D016017:Odds Ratio; D011292:Premedication; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole