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Candidemia in pediatric surgery patients
E M Mokaddas1, S A Ramadan, S H Abo el Maaty
1Department of Microbiology, Ibn Sina Hospital, Kuwait.
Insights
Candidemia is infrequent in pediatric surgery intensive care units (ICUs). Key risk factors include ICU stay, gastrointestinal surgery, and broad-spectrum antibiotic use.
Area of Science:
- Infectious Diseases
- Pediatric Surgery
- Critical Care Medicine
Background:
- Candida species are a significant cause of bloodstream infections.
- Neonatal candidemia is well-documented, but its incidence in pediatric surgery is less studied.
- This research addresses the gap in understanding candidemia in pediatric surgical patients.
Purpose of the Study:
- To determine the prevalence of candidemia in pediatric surgery intensive care unit (ICU) patients.
- To identify neonatal and hospital risk factors associated with candidemia.
- To compare risk factors between candidemia, bacteremia, and non-infected patient groups.
Main Methods:
- A 5-year prospective study involving 1,359 pediatric surgery patients in ICU/HDU.
- Microbiological surveys were conducted on admission and weekly.
- Patients were categorized into candidemia, bacteremia, and no infection groups for comparison.
Main Results:
- Twenty-five patients developed candidemia, with 21 in the ICU.
- Common risk factors for candidemia included ICU stay, prior broad-spectrum antibiotics, and gastrointestinal surgery.
- Candida albicans and Candida parapsilosis were the most common isolates.
Conclusions:
- Candidemia is infrequent but serious in pediatric surgery patients.
- Intensive care unit (ICU) stay, gastrointestinal surgery, and broad-spectrum antibiotic therapy are significant risk factors.
- Early identification and management are crucial for improving outcomes.
Abstract:
Candida spp. are the fourth leading cause of bloodstream infection. While the literature on neonatal candidemia is abundant, its prevalence in pediatric surgery cases is hardly mentioned. This study was carried out over a 5-year period to evaluate the prevalence of candidemia in pediatric surgery intensive care unit patients (ICU), and to examine both the neonatal and hospital risk factors for developing candidemia in comparison to control groups of patients with either no infection or with bacteremia, type and outcome of therapy. A total of 1,359 pediatric surgery patients admitted to the ICU and high dependency unit (HDU) were included in the study. Using relevant specimens from them, a microbiological survey was carried out on admission and weekly thereafter. Twenty-five patients developed candidemia during the study period. Twenty-one of them were admitted to ICU. Nine were low birth weight and immature neonates. All 25 patients had underlying disease, most involving the gastroentestinal tract and requiring surgical intervention. All patients had been given broad-spectrum beta-lactam antibiotics with or without aminoglycosides and an anti-anaerobic drug prior to candidemia. The data show that patients who were not infected had very few risk factors that could predispose to candidemia. The bacteremic group of patients had more risk factors: mainly ICU stay, prior antibiotic therapy or GI surgery. The candidemia patients outnumbered these two groups in both neonatal and hospital risk factors. Twenty-three candidemia patients had received amphotericin B and 2 had fluconazole. Seventeen of them improved and the rest expired during therapy. Fourteen of the Candida isolated were C. albicans while the rest belonged to other Candida spp. dominated by C. parapsilosis. In conclusion, candidemia was infrequent in pediatric surgery patients. ICU stay, GI surgery and prior broad-spectrum antibiotic therapy were important risk factors.