Hostname: page-component-6dbcb7884d-lhnfz Total loading time: 0 Render date: 2025-02-13T16:30:39.745Z Has data issue: false hasContentIssue false
  • English
  • Français

Incidence, Classification, and Risk Stratification for Candida Central Line–Associated Bloodstream Infections in Pediatric Patients at a Tertiary Care Children's Hospital, 2000–2010

Published online by Cambridge University Press:  02 January 2015

J. Michael Klatte ,
Jason G. Newland  and
Mary Anne Jackson
J. Michael Klatte*
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics and University of Missouri–Kansas City, Missouri
Jason G. Newland
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics and University of Missouri–Kansas City, Missouri
Mary Anne Jackson
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics and University of Missouri–Kansas City, Missouri
*
Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To identify risk factors for pediatric Candida central line-associated bloodstream infections (CLABSIs).

Design.

Retrospective case-control study.

Setting.

Freestanding tertiary care children's hospital.

Patients.

Patients with Candida CLABSI from January 31, 2000, through December 31, 2010, compared with age- and year-matched controls.

Methods.

Demographics, comorbidities, presence of indwelling foreign bodies, exposure to antibiotics or corticosteroids, total parenteral nutrition (TPN) or blood transfusions, complications, and outcome were evaluated. Bivariate and then logistic regression were used to compare temporal trends and risk factors.

Results.

A total of 160 Candida CLABSI patients (median age, 1.96 years) were compared with 457 controls. Those with Candida CLABSIs were more likely to have intestinal failure (adjusted odds ratio [aOR], 6.777 [95% confidence interval (CI), 2.315–19.839]; P < .001), to have a gastrostomy tube in place (aOR, 4.156 [95% CI, 2.317–7.456]; P < .001), and to receive TPN (aOR, 3.897 [95% CI, 2.403–6.319]; P < .001) or blood transfusions (aOR, 2.990 [95% CI, 1.841–4.856]; P < .001), and they had a 3-fold increase in mortality (aOR, 3.543 [95% CI, 1.501–8.364]; P = .004). Candida albicans was most common, but non-albicans strains resistant to amphotericin (C. lusitaniae) and fluconazole (C. glabrata and C. krusei) were also found.

Conclusions.

Those patients with intestinal failure, gastrostomy tube presence, and/or receipt of TPN and blood transfusions are at increased risk for development of Candida CLABSI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 12 , December 2013 , pp. 1266 - 1271
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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.Wylie, MC, Graham, DA, Potter-Bynoe, G, et al. Risk factors for central line-associated bloodstream infection in pediatric intensive care units. Infect Control Hosp Epidemiol 2010;31:1049–1056.Google Scholar
2.Niedner, MF, Huskins, WC, Colantuoni, E, et al. Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infect Control Hosp Epidemiol 2011;32:1200–1208.Google Scholar
3.Mahieu, LM, De Dooy, JJ, Lenaerts, AE, Ieven, MM, De Muynck, AO. Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients. J Hosp Infect 2001;48:20–26.Google Scholar
4.Costello, JM, Graham, DA, Morrow, DF, et al. Risk factors for central line-associated bloodstream infection in a pediatric cardiac intensive care unit. Pediatr Crit Care Med 2009;10:453–459.CrossRefGoogle Scholar
5.Jácomo, VR, Tresoldi, AT. Risk factors for central venous catheter-related infections in pediatric intensive care. Clinics (Sao Paulo) 2007;62:537–544.Google Scholar
6.Posteraro, B, Bruno, S, Boccia, S, et al. Candida pampsitosis bloodstream infection in pediatrie oncology patients: results of an epidemiologic investigation. Infect Control Hosp Epidemiol 2004;25:641–645.Google Scholar
7.Benjamin, DK Jr, Stoll, BJ, Gantz, MG, et al. Neonatal candidiasis: epidemiology, risk factors, and clinical judgement. Pediatrics 2010;126:e865–e873.CrossRefGoogle Scholar
8.Filioti, J, Spiroglou, K, Roilides, E. Invasive candidiasis in pediatric intensive care patients: epidemiology, risk factors, management, and outcome. Intensive Care Med 2007;33:1272–1283.CrossRefGoogle ScholarPubMed
9.Zaoutis, TE, Greves, HM, Lautenbach, E, Bilker, WB, Coffin, SE. Risk factors for disseminated candidiasis in children with can-didemia. Pediatr Infect Dis J 2004;23:635–641.Google Scholar
10.Belet, N, Ciftci, E, Aysev, D, et al. Invasive Candida infections in children: the clinical characteristics and species distribution and antifungal susceptibility of Candida spp. Turk J Pediatr 2011;53:489–498.Google Scholar
11.Drews, BB, Sanghavi, R, Siegel, JD, Metealf, P, Mittal, NK. Characteristics of catheter-related bloodstream infections in children with intestinal failure. Gastroenterol Nurs 2009;32:385–390.CrossRefGoogle ScholarPubMed
12.Simon, A, Bode, U, Beutel, K. Diagnosis and treatment of catheter-related infections in paediatric oncology: an update. Clin Microbiol Infect 2006;12:606–620.CrossRefGoogle ScholarPubMed
13.Adler, A, Yaniv, I, Solter, E, et al. Catheter-associated bloodstream infections in pediatric hematology-oncology patients: factors associated with catheter removal and recurrence. J Pediatr Hematol Oncol 2006;28:23–28.Google Scholar
14.Benjamin, DK Jr, Stoll, BJ, Fanaroff, AA, et al. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics 2006;117:84–92.CrossRefGoogle ScholarPubMed
15.Hosaka, Y, Koslowski, M, Nuding, S, et al. Antimicrobial host defense in the upper gastrointestinal tract. Eur J Gastroenterol Hepatol 2008;20:1151–1158.Google Scholar
16.Kiehne, K, Brunke, G, Meyer, D, Harder, J, Herzig, K. Oesophageal defensin expression during Candida infection and reflux disease. Scand J Gastroenterol 2005;40:501–507.CrossRefGoogle ScholarPubMed
17.Vordenbäumen, S, Pilie, D, Otte, J, Schmitz, F, Schmidt-Choudhury, A. Defensins are differentially expressed with respect to the anatomic region in the upper gastrointestinal tract of children. J Pediatr Gastroenterol Nutr 2009:49:139–142.CrossRefGoogle Scholar
18.Porter, EM, van Dam, E, Valore, EV, Ganz, T. Broad-spectrum antimicrobial activity of human intestinal defensin 5. Infect Immun 1997;65:2396–2401.Google Scholar
19.Dato, VM, Dajani, AS. Candidemia in children with central venous catheters: role of catheter removal and amphotericin B therapy. Pediatr Infect Dis J 1990;9:309–314.Google Scholar
20.Ching, YA, Modi, BP, Jaksic, T, Duggan, C. High diagnostic yield of gastrointestinal endoscopy in children with intestinal failure. J Pediatr Surg 2008;43:906–910.Google Scholar
21.Conti, HR, Gaffen, SL. Host responses to Candida albicans: Thl7 cells and mucosal candidiasis. Microbes Infect 2010;12:518–527.Google Scholar
22.Pappas, PG, Kauffman, CA, Andes, D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;48:503–535.CrossRefGoogle ScholarPubMed
23.Zaoutis, TE, Prasad, PA, Localio, AR, et al. Risk factors and predictors for candidemia in pediatric intensive care unit patients: implications for prevention. Clin Infect Dis 2010;51:e38–e45.CrossRefGoogle ScholarPubMed
24.Oliveira, C, Nasr, A, Brindle, M, Wales, PW. Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta-analysis. Pediatrics 2012;129:318–329.CrossRefGoogle ScholarPubMed
25.Shenep, LE, Shenep, MA, Cheatham, W, et al. Efficacy of intravascular catheter lock solutions containing preservatives in the prevention of microbial colonization. J Hosp Infect 2011;79:317–322.Google Scholar
26.Cober, MP, Kovacevich, DS, Teitelbaum, DH. Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure. J Parenter Enteral Nutr 2011;35:67–73.Google Scholar