Risk factors for candidemia mortality in hospitalized children☆

Motta, Fabio Araujo; Dalla-Costa, Libera Maria; Muro, Marisol Dominguez; Cardoso, Mariana Nadal; Picharski, Gledson Luiz; Jaeger, Gregory; Burger, Marion

doi:10.1016/j.jped.2016.05.007

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Original articles • J. Pediatr. (Rio J.) 93 (2) • Mar/Apr 2017 • https://doi.org/10.1016/j.jped.2016.05.007 copy

Risk factors for candidemia mortality in hospitalized children^☆ ☆ Please cite this article as: Motta FA, Dalla-Costa LM, Muro MD, Cardoso MN, Picharski GL, Jaeger G, et al. Risk factors for candidemia mortality in hospitalized children. J Pediatr (Rio J). 2017;93:165-71.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate risk factors associated with death due to bloodstream infection caused by Candida spp. in pediatric patients and evaluate the resistance to the main anti-fungal used in clinical practice.

Methods:

This is a cross-sectional, observational, analytical study with retrospective collection that included 65 hospitalized pediatric patients with bloodstream infection by Candida spp. A univariate analysis was performed to estimate the association between the characteristics of the candidemia patients and death.

Results:

The incidence of candidemia was 0.23 cases per 1000 patients/day, with a mortality rate of 32% (n = 21). Clinical outcomes such as sepsis and septic shock (p = 0.001), comorbidities such as acute renal insufficiency (p = 0.01), and risks such as mechanical ventilation (p = 0.02) and dialysis (p = 0.03) are associated with increased mortality in pediatric patients. The resistance and dose-dependent susceptibility rates against fluconazole were 4.2% and 2.1%, respectively. No resistance to amphotericin B and echinocandin was identified.

Conclusion:

Data from this study suggest that sepsis and septic shock, acute renal insufficiency, and risks like mechanical ventilation and dialysis are associated with increased mortality in pediatric patients. The mortality among patients with candidemia is high, and there is no species difference in mortality rates. Regarding the resistance rates, it is important to emphasize the presence of low resistance in this series.

KEYWORDS
Candidemia; Pediatric mortality; Bloodstream infection; Blood culture

Species	Number of isolates	Percentage
C. albicans	24	37%
C. parapsilosis	20	31%
C. tropicalis	5	8%
C. guilliermondii	3	5%
C. haemulonii	3	5%
C. krusei	2	3%
C. glabrata	2	3%
Others^a a Other species - C. lusitaniae (1), C. pelliculosa (1); C. intermedia (1), C. famata (1), C. norvegiensis (1); C. lipolytica (1).	6	12%

Variable	Number of patients			Percentage of death (%)	p-Value
Variable	Survival	Death	Total (%)	Percentage of death (%)	p-Value
Age					0.12
<28 days (neonatal)	3	5	8 (12.3)	62.5
28 days to 2 years	20	10	30 (46.2)	33.3
>2 years	21	6	27 (41.5)	22.2
Identified species					0.79
C. albicans	17	7	24 (36.9)	29.2
Other species	27	14	41 (63.1)	34.1
Associated bacteremia prior or during candidemia					0.52
Yes	11	3	14 (21.5)	21.4
No	33	18	51 (78.5)	35.3
Blood culture performed within 30 days after candidemia					0.001
No	3	7	10 (15.4)	70.0
Yes, negative	27	2	29 (44.6)	6.9
Yes, positive for bacteria	5	4	9 (13.8)	44.4
Yes, positive for Candida of the same species	9	8	17 (22.1)	47.1
Hospital unit					0.11
Non-ICU	25	7	32 (49.2)	21.8
ICU	19	14	33 (50.8)	42.4
Severity of illness (fever, hypotension, septic shock)					0.001
Other (hypotension and/or septic shock)	4	10	14 (21.9)	71.4
Only fever	28	4	32 (50)	12.5
None of the above	11	7	18 (28.1)	38.9
Catheter (CVC, PICC, arterial, or totally implanted catheter)					0.78
Yes	30	13	43 (66.2)	30.2
No	14	8	22 (33.8)	36.4
Prior pathological conditions ^a a Prior pathological conditions: pulmonary disease, prematurity, cancer, human immunodeficiency virus (HIV), heart disease, neurological disease, transplantation, acute and chronic renal insufficiency, mucositis, and/or neutropenia.
Group 1					0.71
Prior pathological conditions except pulmonary disease	36	16	52 (83.9)	30.8
At least pulmonary disease	6	4	10 (16.1)	40.0
Group 2					0.75
Prior pathological conditions except neurological disease	33	15	48 (77.4)	31.3
At least neurological disease	9	5	14 (22.6)	35.7
Group 3					0.27
Prior pathological conditions except mucositis	37	15	52 (83.9)	28.8
At least mucositis	5	5	10 (16.1)	50.0
Group 4					0.01
Prior pathological conditions except acute renal insufficiency	40	14	54 (87.1)	25.9
At least acute renal insufficiency	2	6	8 (12.9)	75.0
Group 6					0.74
Prior pathological conditions except cancer	34	15	49 (79)	30.6
At least cancer	8	5	13 (21)	38.5
Potential risk factors (RF) ^b b Potential risk factors: parenteral nutrition, mechanical ventilation, dialysis, and neutropenia.
Group 1					0.42
Other (parenteral nutrition, mechanical ventilation, and/or dialysis)	15	11	26 (40)	42.3
None of the assessed RF	20	7	27 (41.5)	25.9
At least^c c At least: the patient has at least one risk factor assessed, whether or not combined with other factors. neutropenia	9	3	12 (18.5)	25.0
Group 2					0.39
Other (mechanical ventilation, dialysis, and/or neutropenia)	15	6	21 (32.3)	28.6
None of the assessed RF	20	7	27 (41.5)	25.9
At least parenteral nutrition	9	8	17 (26.2)	47.1
Group 3					0.02
Other (parenteral nutrition, dialysis, and/or neutropenia)	13	2	15 (23.1)	13.3
None of the assessed RF	20	7	27 (41.5)	25.9
At least mechanical ventilation	11	12	23 (35.4)	52.2
Group 4					0.03
Other (parenteral nutrition, mechanical ventilation, and/or neutropenia)	23	9	32 (49.2)	28.1
None of the assessed RF	20	7	27 (41.5)	25.9
At least dialysis	1	5	6 (9.2)	83.3

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[1] * Corresponding author. E-mail:fabio.motta.hpp@gmail.com (F.A. Motta).

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Risk factors for candidemia mortality in hospitalized children☆ ☆ Please cite this article as: Motta FA, Dalla-Costa LM, Muro MD, Cardoso MN, Picharski GL, Jaeger G, et al. Risk factors for candidemia mortality in hospitalized children. J Pediatr (Rio J). 2017;93:165-71.

Abstract

Objective:

Methods:

Results:

Conclusion:

Risk factors for candidemia mortality in hospitalized children^☆ ☆ Please cite this article as: Motta FA, Dalla-Costa LM, Muro MD, Cardoso MN, Picharski GL, Jaeger G, et al. Risk factors for candidemia mortality in hospitalized children. J Pediatr (Rio J). 2017;93:165-71.