Per-species risk factors and predictors of invasive Candida infections in patients admitted to pediatric intensive care units: development of ERICAP scoring systems.
BACKGROUND
Prediction rules for invasive Candida infection (ICI) are available for adult but not for infants and children managed in pediatric intensive care units (PICU).


METHODS
Observational study in 24 PICU with prospective phase (all children admitted during 1 year) and retrospective review of ICI records. Four logistic regression models were performed using ICI by Candida spp., Candida albicans, Candida parapsilosis or Candida tropicalis as dependent variables. Scores were constructed.


RESULTS
One hundred and twenty five ICI (47 C. albicans, 37 C. parapsilosis, 19 C. tropicalis and 22 others) and 1022 controls were included. Incidence (cases/100 PICU admissions): 4.22 (all Candida), 2.44 (C. albicans), 1.41 (C. parapsilosis), 0.19 (C. tropicalis). ICI was associated [Area under the receiver operating characteristics curve (AUC) = 0.764, 95% confidence interval (CI) = 0.719-0.809, P < 0.001] with pre-PICU hospitalization ≥ 15 days [odds ratio (OR) = 3.3; score: +3], fever (OR = 2.6; +2), thrombopenia (OR = 2.0; +1) and parenteral nutrition (OR=2.4; +2). Additionally, the following associations were noted: C. albicans ICI (AUC = 0.716, 95% CI = 0.640-0.792, P < 0.001) with chronic metabolic disease (OR = 10.7; score:+4), surgical digestive process (OR = 2.8; +1), fever (OR = 2.8; +1) and parenteral nutrition (OR = 2.3; +1); C. parapsilosis ICI (AUC = 0.808, 95% CI = 0.739-0.877, P < 0.001) with previous colonization (OR = 7.1; score:+3), tracheostomy (OR = 5.1; +2), parenteral nutrition (OR = 4.3; +2), thrombopenia (OR = 3.6; +1) and previous bacterial infection (OR = 3.0; +1) and ICI by C. tropicalis (AUC = 0.941, 95% CI=0.886-0.995, P < 0.001) with thrombopenia (OR = 53.8; score: +10), neutropenia (OR = 7.2; +1), pre-PICU hospitalization ≥ 15 days (OR = 17.2; +3) and hematologic (OR = 22.4; +4) and cardiovascular infectious processes (OR = 5.5; +1). Specificity was >90% for cut offs of 5 (all Candida), 3 (C. albicans), 3 (C. parapsilosis) and 11 (C. tropicalis).


CONCLUSIONS
Once validated, these scores may help for identification of ICI by specific species allowing adequate empiric/prophylactic treatment.
From the *Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona; †Intensive Care Unit, Hospital Infantil Virgen del Rocio, Sevilla; ‡Pediatric Intensive Care Unit, Hospital 12 de Octubre; §Pediatric Intensive Care Unit, Hospital La Paz; ¶Intensive Care Unit, Hospital Niño Jesus, Madrid; ‖Intensive Care Unit, Hospital Infantil Miguel Servet, Zaragoza; **Pediatric Intensive Care Unit, Hospital Universitario Puerta del Mar, Cadiz; ††Medical Department, Astellas Pharma S.A.; and ‡‡Microbiology Unit, Medicine Department, School of Medicine, Universidad Complutense, Madrid, Spain.
Iolanda
I
Jordan
Monica
M
Balaguer
José-Domingo
JD
López-Castilla
Sylvia
S
Belda
Cristina
C
Shuffelman
Maria-Angeles
MA
Garcia-Teresa
Paula
P
Madurga
Jose-Carlos
JC
Flores-Gonzalez
Paloma
P
Anguita
Lorenzo
L
Aguilar
D002175:Candida / Q000302:isolation & purification*; D058365:Candidiasis, Invasive / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology