Risk factors for candidemia in pediatric patients with congenital heart disease

Objective. To identify the main risk factors for the acquisition of candidemia in children with congenital heart disease ( CHD) in order to improve the clinical management of these patients. Design. A case-control study. Setting. A large tertiary-care referral center in Spain with a pediatric intensive care unit (PICU) to which more than 500 children with CHD are admitted annually. Patients. All patients had CHD and were admitted to the PICU during 1995-2000. Case patients were defined as patients with candidemia, and control patients were defined as patients without candidemia. Results. Twenty-eight case patients and 47 control subjects were included in the study. Case patients were younger ( mean age [ +/- SD], 12.5 +/- 32.0 vs 38.0 +/- 48.0 months; P<.01) and had a longer median PICU stay (19 vs 4 days; P<.01), and a greater percentage of case patients previously had Candida species isolated from specimens other than blood (eg, bronchial aspirates, urine, or skin specimens) ( 39% vs 4%; P<.01). Severity of clinical condition, as measured by the Therapeutic Intervention Scoring System ( TISS) 1 week after PICU admission (odds ratio, 1.15; 95% confidence interval, 1.05-1.26; P<.01), and receipt of antibiotic treatment for more than 5 days ( odds ratio, 13.42; 95% confidence interval, 1.31-137.13; P<.03) were independently associated with the development of candidemia. Conclusions. Patients with CHD who have a high TISS score 1 week after PICU admission and patients who have received prolonged antibiotic therapy should be considered at high risk for candidemia. Our results suggest that shorter courses of antibiotic therapy, routine surveillance culture for Candida species, and initiation of preemptive or empirical antifungal treatment could help in the clinical management of these patients.