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Candidaemia in a paediatric centre and importance of central venous catheter removal
Author(s) -
KaradagOncel Eda,
Kara Ates,
Ozsurekci Yasemin,
ArikanAkdagli Sevtap,
Cengiz Ali Bulent,
Ceyhan Mehmet,
Gur Deniz,
Celik Melda,
OzkayaParlakay Aslinur
Publication year - 2015
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.12288
Subject(s) - medicine , mechanical ventilation , central venous catheter , candida tropicalis , candida albicans , retrospective cohort study , candida parapsilosis , gastroenterology , catheter , surgery , biology , antifungal , microbiology and biotechnology , dermatology
Summary The aim of this study is to identify differences in distribution of Candida species , 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, n = 51; Group 2, ≥3 months, n = 197) to identify any potential difference between the neonatal and early infantile periods in terms of risk factors and distribution of Candida species. A total of 248 distinct episodes of candidaemia were identified over the study period. The most frequently isolated Candida species were C. albicans (53.2%), followed by C. parapsilosis (26.2%), C. tropicalis (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); P < 0.001], compared to a 5.9‐fold increased risk with hypoalbuminaemia [95% CI (1.03, 34.1); P = 0.046]. For Group 2, the increased risk was 23‐fold for failure of CVC removal [95% CI (7.48, 70.77); P < 0.001], 7.4‐fold for mechanical ventilation [95% CI (2.64, 21.08); P < 0.001], 4.4‐fold for hypoalbuminaemia [95% CI (1.56, 12.56); P = 0.005], 3.1‐fold for neutropaenia [95% CI (1.31, 7.69); P = 0.010] and 2.2‐fold for male gender [95% CI (1.02, 4.71); P = 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.