Candidemia in pediatric patients with congenital heart disease

• Published in: Diagnostic microbiology and infectious disease 2006-07, Vol.55 (3), p.203-207
• Main Authors: San Miguel, Lucía García, Cobo, Javier, Otheo, Enrique, Martos, Isabel, Muriel, Alfonso, Fortún, Jesús, Moreno, Santiago
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Candida parapsilosis; Candidemia; Candidiasis - complications; Candidiasis - mortality; Cardiac; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Catheters, Indwelling - microbiology; Child; Child, Preschool; Cross Infection - complications; Cross Infection - microbiology; Cross Infection - mortality; Fundamental and applied biological sciences. Psychology; Fungemia - complications; Fungemia - microbiology; Fungemia - mortality; Heart Defects, Congenital - microbiology; Heart Defects, Congenital - mortality; Humans; Infant; Infant, Newborn; Infection; Infectious diseases; Intensive care unit; Intensive Care Units, Neonatal; Intensive Care Units, Pediatric; Medical sciences; Microbiology; Miscellaneous; Mycology; Nosocomial; Pediatric
• ISSN: 0732-8893; 1879-0070
• DOI: 10.1016/j.diagmicrobio.2006.01.016

Candidemia is an important problem in pediatrics. In our hospital, highest candidemia rates were documented among children with congenital heart disease (CHD). A series was conducted to describe the clinical and mortality features of candidemia in these patients. Fifty-two cases (1988–2000) included very young infants (median age, 2 months) who received long-term antibiotic treatment (median, 20.5 days). Candida parapsilosis predominated (54%). Endovascular infections occurred in 11.5%. In-hospital mortality was 39% and related mortality 14%. Maintenance of catheter (odds ratio [OR], 6.0; 95% confidence interval [CI], 1.0–37.2; P = .05) and severity of patients as measured with the Pediatric Risk Score of Mortality I (OR, 1.1, 95% CI, 1.0–1.3; P = .05) were independently associated with mortality. In summary, candidemia in children with CHD is diagnosed to very young infants with prolonged antibiotic therapy. Mortality is high but, in most cases, is not related to candidemia. Optimal management may include exclusion of endocarditis, early antifungal treatment, and catheter removal.