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Candidemia in pediatric outpatients receiving home total parenteral nutrition

M V Cano1, J F Perz, A S Craig

  • 1Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. mcano@cdc.gov

Medical Mycology
|July 14, 2005
PubMed

Insights

Pediatric patients on home total parenteral nutrition (TPN) had a high rate of candidemia, particularly Candida parapsilosis. Caregivers and patients frequently harbored Candida, highlighting infection control challenges in home care.

Area of Science:

  • Infectious Diseases
  • Pediatric Medicine
  • Clinical Microbiology

Background:

  • Increased incidence of candidemia in pediatric outpatients receiving total parenteral nutrition (TPN).
  • Candida parapsilosis identified as a causative agent in several cases.

Purpose of the Study:

  • To investigate the incidence and potential sources of candidemia in pediatric patients on home TPN.
  • To assess the role of healthcare providers and family members in candidemia transmission.

Main Methods:

  • Cohort study of pediatric outpatients receiving home TPN between January and June 1999.
  • Microbiological cultures (including hand cultures) and molecular typing (karyotyping, RAPD) of Candida isolates.
  • Statistical analysis to identify risk factors for candidemia.

Main Results:

  • Five of 13 pediatric patients on home TPN developed candidemia; three were caused by Candida parapsilosis.
  • Underlying hematologic disease and previous fungemia were associated with candidemia (P = 0.02).
  • Candida spp. were frequently isolated from hand cultures of patients (40%) and caregivers (82%), including C. parapsilosis from five caregivers.

Conclusions:

  • Home TPN care presents significant infection control challenges.
  • Close contact with caregivers and environmental contamination may contribute to candidemia in pediatric patients.
  • Enhanced follow-up and coordination of home TPN therapy are crucial for pediatric patients.

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