Risk factors for nosocomial candidaemia: a case-control study in children

Candida spp. are increasingly important nosocomial pathogens in critically ill children. Data on risk factors of acquisition in children with candidaemia are limited. To determine the incidence, prognosis and risk factors for acquisition of nosocomial candidaemia in children, a prospective case-control study was performed between July 1998 and January 2000. Candidaemia was defined as the presence of at least one positive blood culture containing Candida spp. For each case, two controls were selected and matched for time and site of hospital admission. Logistic regression was used to obtain estimates of risk after simultaneous control for other variables. Candidaemia was diagnosed in 24 children (1.09/1000 admissions). The species most frequently isolated were Candida albicans (50%) and Candida parapsilosis (17%). Mean age was 58.2+/-58 months between cases and 41.8+/-52.2 months in controls (P not significant). The strongest risk factors for acquisition found in the univariate analysis were underlying disease, previous antibiotic treatment, the number of antibiotics administered, presence of a long-duration catheter and total parenteral nutrition (P<0.05). Sex, the site of hospital admission, artificial ventilatory assistance, transitory venous catheters, arterial and peripherally venous accesses, bladder catheter and transfusions were not statistically significant. The risk factors identified by multiple logistic regression analysis were: permanent catheter (OR 31.5; 3.19-310) and total parenteral nutrition (OR 10.5; 2.76-40.0). Nine (37%) children with nosocomial candidaemia and seven (15%) controls died (P=0.05). These findings should facilitate development of rational approaches to preventing infection and assist clinicians in identifying those patients in whom this life-threatening complication is likely to occur.