Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-23T04:02:00.752Z Has data issue: false hasContentIssue false
  • English
  • Français

Analysis of Independent Risk Factors for Death Among Pediatric Patients With Candidemia and a Central Venous Catheter in Place

Published online by Cambridge University Press:  02 January 2015

Alessandro C. Pasqualotto ,
Anaelena B. de Moraes ,
Roselaine R. Zanini  and
Luiz Carlos Severo
Alessandro C. Pasqualotto*
Affiliation:
Department of Infection Control, Santa Casa Complexo Hospitalar, School of Medicine, University of Manchester, United Kingdom
Anaelena B. de Moraes
Affiliation:
Programa de Pôs-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, United Kingdom
Roselaine R. Zanini
Affiliation:
Programa de Pôs-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, United Kingdom
Luiz Carlos Severo
Affiliation:
Mycology Laboratory, Santa Casa Complexo Hospitalar, Porto Alegre, RS, Brazil
*
1/512 Wilmslow Road, Manchester, M20 4BT, United Kingdom ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To use multivariate analysis to determine risk factors for death among pediatric patients with candidemia and a central venous catheter in place.

Design.

Retrospective cohort study conducted at Santa Casa Complexo Hospitalar, a 1,200-bed teaching hospital in southern Brazil.

Methods.

All cases of candidemia in pediatric patients (age, ≤ 13 years) at our medical center over a 9-year period were reviewed. A diagnosis of sepsis was required for inclusion in the study. Severity of illness was confirmed by the presence of hypotension requiring inotropes and according to the following scores: the Pediatric Risk of Mortality (PRISM) II score, the PRISM III score, and the Pediatric Logistic Organic Dysfunction score. The following 2 outcomes were evaluated: early death, defined as death occurring within 7 days after candidemia was diagnosed, and late death, defined as death 8-30 days after candidemia was diagnosed.

Results.

A total of 61 patients were included in the study, including 14 neonates. Most (63.9%) of these patients were girls, and the median age was 0.3 years. A total of 80.3% of candidemia cases were due to species other than Candida albicans, primarily Candida parapsilosis (32.8% of cases) and Candida tropicalis (24.6% of cases). Using multivariate analysis, we demonstrated that failure to remove the central venous catheter was an independent risk factor for early death among pediatric patients with candidemia. However, patients whose catheters were retained were sicker than patients whose catheters were removed, and catheter removal had no impact on late death. Instead, severity of illness determined using the PRISM III score was also an independent predictor of late death.

Conclusions.

Results from this study suggest that systematic removal of catheters from pediatric patients with candidemia does not reduce the occurrence of late death.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 799 - 804
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Gudlaugsson, O, Gillespie, S, Lee, K, et al.Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis 2003;37:1172–1177.CrossRefGoogle ScholarPubMed
2.Morgan, I, Meitzer, MI, Plikaytis, BD, et al.Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance. Infect Control Hosp Epidemiol 2005;26:540–547.CrossRefGoogle ScholarPubMed
3.Zaoutis, TE, Argon, J, Chu, J, Berlin, JA, Walsh, TJ, Feudtner, C. The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis. Clin Infect Dis 2005;41:1232–1239.CrossRefGoogle ScholarPubMed
4.Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Effects of nosocomial candidemia on outcomes of critically ill patients. Am f Med 2002;113:480–485.CrossRefGoogle ScholarPubMed
5.Viudes, A, Peman, J, Canton, E, Ubeda, P, Lopez-Ribot, JL, Gobernado, M. Candidaemia at a tertiary-care hospital: epidemiology, treatment, clinical outcome and risk factors for death. Eur J Clin Microbiol Infect Dis 2002;21:767–774.Google Scholar
6.Pasqualotto, AC, Nedel, WL, Santini, TS, Severo, LC. A 9-year study comparing risk factors and the outcome of paediatrics and adults with nosocomial candidaemia. Mycopathologia 2005;160:111–116.CrossRefGoogle ScholarPubMed
7.Pappas, PG, Rex, JH, Lee, J, et al.A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis 2003;37:634–643.CrossRefGoogle ScholarPubMed
8.Yamamura, DL, Rotstein, C, Nicolle, LE, Ioannou, S. Candidaemia at selected Canadian sites: results from the Fungal Disease Registry, 1992-1994. Fungal Disease Registry of the Canadian Infectious Disease Society. CMAJ 1999;160:493–499.Google ScholarPubMed
9.Zaoutis, TE, Coffin, SE, Chu, JH, et al.Risk factors for mortality in children with candidemia. Pediatr Infect Dis J 2005;24:736–739.CrossRefGoogle ScholarPubMed
10.Singhi, SC, Reddy, TC, Chakrabarti, A. Candidemia in a pediatric intensive care unit. Pediatr Crit Care Med 2004;5:369–374.CrossRefGoogle Scholar
11.Pacheco-Rios, A, Avila-Figueroa, C, Nobigrot-Kleinman, D, Santos, JI. Mortality associated with systemic candidiasis in children. Arch Med Res 1997;28:229–232.Google ScholarPubMed
12.San Miguel, LG, Cobo, J, Otheo, E, et al.Candidemia in pediatrie patients with congenital heart disease. Diagn Microbiol Infect Dis 2006;55:203–207.CrossRefGoogle Scholar
13.Goldstein, B, Giroir, B, Randolph, A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2–8.CrossRefGoogle ScholarPubMed
14.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
15.Mermel, LA, Farr, BM, Sherertz, RJ, et al.Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001;32:1249–1272.CrossRefGoogle ScholarPubMed
16.Pasqualotto, AC, Nedel, WL, Santini, TS, Severo, LC. A comparative study of risk factors and outcome among outpatient-acquired and nosocomial candidaemia. J Hosp Infect 2005;60:129–134.CrossRefGoogle ScholarPubMed
17.Almirante, B, Rodriguez, D, Park, BJ, et al.Epidemiology and predictors of mortality in cases of Candida bloodstrem infection: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol 2005;43:1829–1835.CrossRefGoogle ScholarPubMed
18.Pollack, MM, Ruttimann, UE, Getson, PR. Pediatric Risk of Mortality (PRISM) score. Crit Care Med 1988;16:1110–1116.CrossRefGoogle ScholarPubMed
19.Pollack, MM, Patel, KM, Ruttimann, EU. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996;24:743–752.CrossRefGoogle ScholarPubMed
20.Leteurtre, S, Martinpt, A, Duhamel, A, et al.Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003;362:192–197.CrossRefGoogle ScholarPubMed
21.Société Française d'Anesthésie et de Réanimation. Scoring systems for ICU and surgical patients. 2007. Available at: http://www.sfar.Org/s/article.php3?id_article = 6,0. Accessed on March 20, 2007.Google Scholar
22.Pappas, PG, Rex, JH, Sobel, JD, et al.Guidelines for treatment of candidiasis. Clin Infect Dis 2004;38:161–189.CrossRefGoogle ScholarPubMed
23.Hawser, SP, Douglas, LJ. Resistance of Candida albicans biofilms to antifungal agents in vitro. Antimicrob Agents Chemother 1995;39:2128–2131.CrossRefGoogle ScholarPubMed
24.Rex, JH, Bennett, JE, Sugar, AM, et al.Intravascular catheter exchange and duration of candidemia. Clin Infect Dis 1995;21:994–996.CrossRefGoogle ScholarPubMed
25.Dato, VM, Dajani, AS. Candidemia in children with central venous catheters: role of catheter removal and amphotericin B therapy. Pediatr Infect Dis 1990;9:309–314.CrossRefGoogle ScholarPubMed
26.Eppes, SC, Troutman, JL, Gutman, LT. Outcome of treatment of candidemia in children whose central catheters were removed or retained. Pediatr Infect Dis J 1989;8:99–104.Google ScholarPubMed
27.Karlowicz, MG, Hashimoto, LN, Kelly, RE, Buescher, ES. Should central venous catheters be removed as soon as candidemia is detected in neonates? Pediatrics 2000;106:E63.CrossRefGoogle Scholar
28.Girmenia, C, Martino, P, Bernardis, FD, Antonucci, G, Cassone, A. Rising incidence of Candida parapsilosis in patients with hematologic malignancies: clinical aspects, predisposing factors, and differential pathogenicity of the causative strains. Clin Infect Dis 1996;23:506–514.CrossRefGoogle ScholarPubMed
29.Lecciones, JA, Lee, JW, Navarro, EE, et al.Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes. Clin Infect Dis 1992;14:875–883.CrossRefGoogle ScholarPubMed
30.Luzzati, R, Amalfitano, G, Lazzarini, L, et al.Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. Eur J Clin Microbiol Infect Dis 2000;19:602–607.CrossRefGoogle ScholarPubMed
31.Anaissie, EJ, Rex, JH, Uzun, O, Vartivarian, S. Predictors of adverse outcome in cancer patients with candidemia. Am J Med 1998;104:238–245.CrossRefGoogle ScholarPubMed
32.Asmundsdottir, LR, Erlendsdottir, H, Gottfredsson, M. Improving survival of patients with candidaemia: analysis of prognostic factors from a long-term, nationwide study in Iceland. Scand J Infect Dis 2005;37:111–120.CrossRefGoogle ScholarPubMed
33.Stamos, JK, Rowley, AH. Candidemia in a pediatric population. Clin Infect Dis 1995;20:571–575.CrossRefGoogle Scholar
34.Ellis, M, Hedstrom, U, Jumaa, P, Bener, A. Epidemiology, presentation, management and Outcome of candidemia in a tertiary care teaching hospital in the United Arab Emirates, 1995-2001. Med Mycol 2003;41:521–528.CrossRefGoogle Scholar
35.Tortorano, AM, Biraghi, E, Astolfi, A, et al.European Confederation of Medical Mycology (ECMM) prospective survey of candidaemia: report from one Italian region. J Hosp Infect 2002;51:297–304.CrossRefGoogle ScholarPubMed
36.Schelenz, S, Gransden, WR. Candidaemia in a London teaching hospital: analysis of 128 cases over a 7-year period. Mycoses 2003;46:390–396.CrossRefGoogle Scholar
37.Kibbler, CC, Seaton, S, Barnes, RA, et al.Management and outcome of bloodstream infections due to Candida species in England and Wales. J Hosp Infect 2003;54:18–24.CrossRefGoogle ScholarPubMed
38.Nguyen, MH, Peacock, JE Jr, Tanner, DC, et al.Therapeutic approaches in patients with candidemia: evaluation in a multicenter, prospective observational study. Arch Intern Med 1995;155:2429–2435.CrossRefGoogle Scholar
39.Raad, I, Hanna, H, Boktour, M, et al.Management of central venous catheters in patients with cancer and candidemia. Clin Infect Dis 2004;38:1119–1127.CrossRefGoogle ScholarPubMed
40.Nucci, M, Colombo, AL, Silveira, F, et al.Risk factors for death in patients with candidemia. Infect Control Hosp Epidemiol 1998;19:846–850.CrossRefGoogle ScholarPubMed
41.Lacroix, J, Cotting, J. Severity of illness and organ dysfunction scoring in children. Pediatr Crit Care Med 2005;6(3 suppl):S126–S134.CrossRefGoogle ScholarPubMed