title: Invasive candidiasis in liver transplant patients: Incidence and risk factors in a pediatric cohort.
abstract: Prolonged OR, re-transplantation, and high-volume intraoperative transfusion have been associated with increased risk for IC in adult LT recipients. Antifungal prophylaxis is recommended for adult patients with these risk factors. There are limited data on the incidence of and risk factors for IC in pediatric LT recipients. A retrospective cohort study of all pediatric LT patients at the CHOP between 2000 and 2012 and the CHP between 2004 and 2012 was performed to define the incidence of IC within 30 days of LT. A 3:1 matched case-control study with incidence density sampling was performed. Conditional logistic regression analyses were used to explore risk factors associated with IC. Among 397 recipients, the incidence of IC was 2.5%. Bivariate analyses showed that ICU admission prior to transplant, OR > 10 h, intraoperative volume infusion of >300 mL/kg, and broad-spectrum antibiotics were significantly associated with IC. In a multivariate model, only ICU admission remained significantly associated with IC. Antifungal prophylaxis was not significantly protective against IC. The low incidence of IC and lack of an identified protective effect from antifungal prophylaxis suggest that prophylaxis in pediatric LT recipients should not be routinely recommended to prevent IC events in the first 30 days post-transplant.
authors.affiliation: University Hospital Pediatric Department, Bambino Gesù Children's Hospital, Rome, Italy.|Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: M
authors.initials: M
authors.lastname: De Luca
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.|The Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Green
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Symmonds
authors.affiliation: Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Klieger
authors.affiliation: The Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Soltys
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Center for Clinical Epidemiology and Biostatistics, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: B T
authors.initials: BT
authors.lastname: Fisher
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D058365:Candidiasis, Invasive / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007432:Intraoperative Period; D017093:Liver Failure / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D015999:Multivariate Analysis; D010343:Patient Admission; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents
keywords: invasive candidiasis; liver transplantation; pediatrics