Candidaemia in a paediatric centre and importance of central venous catheter removal. Issue 3 (10th February 2015)

• Record Type: Journal Article
• Authors: Karadag‐Oncel, Eda; Kara, Ates; Ozsurekci, Yasemin; Arikan‐Akdagli, Sevtap; Cengiz, Ali Bulent; Ceyhan, Mehmet; Gur, Deniz; Celik, Melda; Ozkaya‐Parlakay, Aslinur
• Is Part Of: Mycoses. Volume 58:Issue 3(2015)
• Page Start: 140
• Page End: 148
• Publication Date: 2015-02-10
• Subjects: Pathogenic fungi -- Periodicals; Medical mycology -- Periodicals; 616.969
• DOI: 10.1111/myc.12288
• Languages: English
• ISSNs: 0933-7407

Abstract

<abstract abstract-type="main" id="myc12288-abs-0001"> <title>Summary</title> <p>The aim of this study is to identify differences in distribution of <italic>Candida species</italic>, 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, <italic>n</italic> = 51; Group 2, ≥3 months, <italic>n</italic> = 197) to identify any potential difference between the neonatal and early infantile periods in terms of risk factors and distribution of <italic>Candida</italic> species. A total of 248 distinct episodes of candidaemia were identified over the study period. The most frequently isolated <italic>Candida</italic> species were <italic>C. albicans</italic> (53.2%), followed by <italic>C. parapsilosis</italic> (26.2%), <italic>C. tropicalis</italic> (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); <italic>P</italic> < 0.001], compared to a 5.9‐fold increased risk with hypoalbuminaemia [95% CI (1.03, 34.1); <italic>P</italic> = 0.046]. For Group 2, the increased risk was 23‐fold for failure of CVC removal [95% CI (7.48, 70.77); <italic>P</italic> < 0.001], 7.4‐fold for mechanical ventilation [95% CI (2.64, 21.08); <italic>P</italic> < 0.001], 4.4‐fold for hypoalbuminaemia [95% CI (1.56, 12.56); <italic>P</italic> = 0.005], 3.1‐fold for neutropaenia [95% CI (1.31, 7.69); <italic>P</italic> = 0.010] and 2.2‐fold for male gender [95% CI (1.02, 4.71); <italic>P</italic> = 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.</p> </abstract>