Incidence, classification, and risk stratification for Candida central line-associated bloodstream infections in pediatric patients at a tertiary care children's hospital, 2000-2010.
OBJECTIVE
To identify risk factors for pediatric Candida central line-associated bloodstream infections (CLABSIs).


METHODS
Retrospective case-control study.


METHODS
Freestanding tertiary care children's hospital.


METHODS
Patients with Candida CLABSI from January 31, 2000, through December 31, 2010, compared with age- and year-matched controls.


METHODS
Demographics, comorbidities, presence of indwelling foreign bodies, exposure to antibiotics or corticosteroids, total parenteral nutrition (TPN) or blood transfusions, complications, and outcome were evaluated. Bivariate and then logistic regression were used to compare temporal trends and risk factors. Results. A total of 160 Candida CLABSI patients (median age, 1.96 years) were compared with 457 controls. Those with Candida CLABSIs were more likely to have intestinal failure (adjusted odds ratio [aOR], 6.777 [95% confidence interval (CI), 2.315-19.839]; P< .001), to have a gastrostomy tube in place (aOR, 4.156 [95% CI, 2.317-7.456]; P< .001), and to receive TPN (aOR, 3.897 [95% CI, 2.403-6.319]; P< .001) or blood transfusions (aOR, 2.990 [95% CI, 1.841-4.856]; P< .001), and they had a 3-fold increase in mortality (aOR, 3.543 [95% CI, 1.501-8.364]; P< .004). Candida albicans was most common, but non-albicans strains resistant to amphotericin (C. lusitaniae) and fluconazole (C. glabrata and C. krusei) were also found. Conclusions. Those patients with intestinal failure, gastrostomy tube presence, and/or receipt of TPN and blood transfusions are at increased risk for development of Candida CLABSI.
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City, Missouri.
J Michael
JM
Klatte
Jason G
JG
Newland
Mary Anne
MA
Jackson
D000038:Abscess / Q000382:microbiology*; D001803:Blood Transfusion; D002176:Candida albicans; D041221:Candida glabrata; D041022:Candida tropicalis; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005774:Gastrostomy; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007422:Intestines / Q000503:physiopathology; D008297:Male; D010289:Parenteral Nutrition, Total; D012189:Retrospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers / Q000706:statistics & numerical data