title: Antibiotic overuse as a risk factor for candidemia in an Indian pediatric ICU.
abstract: OBJECTIVE
  To identify risk factors and mycological characteristics of candidemia in Pediatric ICU of a tertiary-care hospital.
  
  
  METHODS
  Patients were screened for candidemia by blood culture. Recovered isolates were speciated and subjected to antifungal susceptibility testing. For every candidemic patient, three controls were matched for age, underlying diagnosis and period of hospitalization. Premature neonates were also matched for birth-weight. Proportion of cases and controls on specific antibiotics or indwelling devices was compared using Chi-square test, while unpaired t-test was used for comparing the number of antibiotics used and the number of days of antibiotic administration. Concordance between susceptibility testing methods was evaluated using Chi-square test.
  
  
  RESULTS
  Significantly wider spectrum of antibiotic coverage was observed among the 28 candidemic patients. While every patient received antibiotic against enteric gram-negative bacilli, antibiotic usage for additional groups of microorganisms was significantly higher among cases. Association of candidemia with increasing use of indwelling devices was also observed. Endogenous colonization was higher in candidemic infants. Candida albicans was the commonest species (n = 18), followed by C. tropicalis (n = 7). Fluconazole and ketoconazole resistance was observed in 10.7 % cases.
  
  
  CONCLUSIONS
  This information on pediatric candidemia could be used to devise locally-tailored strategies for identifying at-risk patients, underline the importance of routine antifungal susceptibility testing and formulate appropriate guidelines for management.
authors.affiliation: Department of Microbiology, Subharti Medical College, Subhartipiram, Meerut, Uttar Pradesh, India.
authors.forename: Charu
authors.initials: C
authors.lastname: Agrawal
authors.forename: Debasis
authors.initials: D
authors.lastname: Biswas
authors.forename: Alpa
authors.initials: A
authors.lastname: Gupta
authors.forename: Bhupendra Singh
authors.initials: BS
authors.lastname: Chauhan
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D002176:Candida albicans / Q000187:drug effects / Q000302:isolation & purification; D058387:Candidemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002408:Catheters, Indwelling / Q000382:microbiology*; D016009:Chi-Square Distribution; D016903:Drug Monitoring / Q000379:methods; D004866:Equipment Contamination / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents