title: Candidaemia in a paediatric centre and importance of central venous catheter removal.
abstract: The aim of this study is to identify differences in distribution of Candida species, resistance to antifungals and clinical outcome, as well as the identification of potential risk factors associated with candidaemia in children. We conducted a retrospective analysis in children ≤18 years with blood culture proven candidaemia identified between 2004 and 2012. Patients were divided into two groups (Group 1, <3 months, n = 51; Group 2, ≥3 months, n = 197) to identify any potential difference between the neonatal and early infantile periods in terms of risk factors and distribution of Candida species. A total of 248 distinct episodes of candidaemia were identified over the study period. The most frequently isolated Candida species were C. albicans (53.2%), followed by C. parapsilosis (26.2%), C. tropicalis (8.1%). Of the 248 episodes, 71 episodes (28.6%) resulted in death within 30 days from the onset of candidaemia. In Group 1, failure of central venous catheter (CVC) removal was found to be associated with a 20.5-fold increase in mortality [95% CI (3.9, 106.5); P < 0.001], compared to a 5.9-fold increased risk with hypoalbuminaemia [95% CI (1.03, 34.1); P = 0.046]. For Group 2, the increased risk was 23-fold for failure of CVC removal [95% CI (7.48, 70.77); P < 0.001], 7.4-fold for mechanical ventilation [95% CI (2.64, 21.08); P < 0.001], 4.4-fold for hypoalbuminaemia [95% CI (1.56, 12.56); P = 0.005], 3.1-fold for neutropaenia [95% CI (1.31, 7.69); P = 0.010] and 2.2-fold for male gender [95% CI (1.02, 4.71); P = 0.043]. Therapeutic choices should be guided by sound knowledge of local epidemiological trends in candidaemia. Removal of CVC significantly reduces mortality and is an essential step in the management of candidaemia.
authors: Pediatric Infectious Disease Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors: Eda
authors: E
authors: Karadag-Oncel
authors: Ates
authors: A
authors: Kara
authors: Yasemin
authors: Y
authors: Ozsurekci
authors: Sevtap
authors: S
authors: Arikan-Akdagli
authors: Ali Bulent
authors: AB
authors: Cengiz
authors: Mehmet
authors: M
authors: Ceyhan
authors: Deniz
authors: D
authors: Gur
authors: Melda
authors: M
authors: Celik
authors: Aslinur
authors: A
authors: Ozkaya-Parlakay
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002176:Candida albicans / Q000302:isolation & purification*; D041022:Candida tropicalis / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D002177:Candidiasis / Q000188:drug therapy; D062905:Central Venous Catheters; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy; D026141:Drug Resistance, Multiple, Fungal; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents
keywords: Candidaemia; central venous catheter; children; mortality; risk factors