Risk Factors and Characteristics of Candidemia After Cardiac Surgery in Pediatric Patients in Central Israel.
Pediatr Infect Dis J
; 42(5): 368-373, 2023 05 01.
Article
em En
| MEDLINE
| ID: mdl-36854105
ABSTRACT
BACKGROUND:
Candidemia is a serious complication in pediatric patients with congenital heart defects (CHD) after cardiac surgery. Information about the epidemiology, clinical characteristics and risk factors for candidemia in this vulnerable population remains limited.METHODS:
This retrospective case-control study was conducted in 2 pediatric intensive care units between 2004 and 2019. All patients <18 years old who developed candidemia following cardiac surgery were included. Each case was matched with 2 control patients based on age and date of surgery. Multivariable logistic regression analysis was conducted to determine the risk factors for postoperative candidemia.RESULTS:
Thirty-five candidemia cases were identified and matched to 70 control cases. The incidence of candidemia was 6.3 episodes per 1000 admissions. The median age for candidemia cases was 4 months. The attributable mortality was 28.5%. The predominant (54%) pathogens isolated were non- albicans Candida species, of which C. parapsilosis isolates demonstrated high resistance to fluconazole (70%). Independent risk factors associated with candidemia included cumulative antibiotic exposure for ≥4 days [OR -4.3; 95% confidence interval (CI) 1.3-14.6; P = 0.02], the need for total parenteral nutrition or peritoneal dialysis (OR -6.1; 95% CI 2-18.8; P = 0.001), male sex (OR 6.2; 95% CI 1.9-20.3; P = 0.002) and delayed sternal closure≥2 days (OR -3.2; 95% CI 1-11.2; P = 0.05).CONCLUSIONS:
Postoperative candidemia in children with CHD is an uncommon but severe complication. Our study revealed an unexpectedly high frequency of fluconazole-resistant C. parapsilosis as the main cause of non- albicans candidemia. In addition to confirming previously recognized risk factors, our results reveal new potential risk factors such as delayed sternal closure and male sex.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Candidemia
/
Procedimentos Cirúrgicos Cardíacos
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Child
/
Humans
/
Infant
/
Male
País/Região como assunto:
Asia
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article