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Risk Factors for Candida Infection among Children Admitted to a Pediatric Intensive Care Unit in a Tertiary Care
Raja Rajeshwari1, Siva Vyasam2, Jolly Chandran3
1Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
Insights
Candida infections are common in critically ill children, with Candida tropicalis being the most frequent species. Key risk factors include neutropenia, mechanical ventilation, and central venous catheters, impacting survival rates.
Area of Science:
- Critical Care Medicine
- Pediatric Infectious Diseases
- Mycology
Background:
- Understanding the clinical profile, risk factors, and outcomes of Candida infections in critically ill children is crucial for improving patient care.
- This study aimed to describe the epidemiology and associated factors of Candida infections in a pediatric intensive care unit (PICU).
Observation:
- A retrospective case-control study included 109 children with Candida growth and 97 matched controls admitted to the PICU between 2015 and 2017.
- Candida non-albicans species, particularly Candida tropicalis (50%), were the predominant isolates.
- Common sites of infection included blood (37%), urine (24%), and endotracheal aspirates (40%).
Findings:
- Significant risk factors for Candida infection included neutropenia, mechanical ventilation, peritoneal dialysis, amino acid administration, central venous catheter presence, and prolonged antibiotic use (>5 days).
- Candida cases exhibited a high incidence of septic shock (95.4%) and acute kidney injury (34%).
- Patients with Candida infection had significantly lower survival rates (66%) compared to controls (80%).
Implications:
- The findings highlight the importance of recognizing Candida tropicalis as a significant pathogen in pediatric intensive care settings.
- Identifying and mitigating risk factors such as neutropenia, invasive devices, and prolonged antibiotic use are essential for preventing Candida infections.
- Improved surveillance and targeted interventions are needed to reduce the morbidity and mortality associated with Candida infections in critically ill children.
Background:
To describe the clinical profile, risk factors, and outcomes that are associated with candida infection among critically ill children.
Patients And Methods:
A retrospective case-control study wherein 109 children admitted to the pediatric intensive care unit (PICU) in the years between 2015 and 2017 with the growth of candida from blood, urine, endotracheal (ET) aspirate, and pus swabs were included and compared to 97 age and sex-matched controls chosen from the same time period.
Results:
Of the 124 candida isolates from 109 children, 37% were from blood, 24% from urine, and 14% in pus; 40% of the isolates were from ET aspirate. Candida non-albicans types (70%) predominated with Candida tropicalis causing 50% of the infections. Risk factors for candida infection were neutropenia [OR 20.01, 95% CI (0.94-422.32)], mechanical ventilation [OR 5.97, 95% CI (2.44-14.62)], peritoneal dialysis [OR 5.81, 95% CI (1.27-26.50)], institution of amino acids [OR 5.41, 95% CI (0.85-34.13)], presence of central venous catheter [OR 3.83, 95% CI (1.59-9.19)], antibiotic use >5 days [OR 3.58, 95% CI (1.38-9.29)]. Candida Cases (95.4%) had a septic shock with acute kidney injury in 34% and had significantly lower survival than controls [72 (66%) of 109 vs. 74 (80%) of 92] (p = 0.023).
Conclusions:
The rate of candida infection in our PICU was 4.2% of PICU admissions. The most common species was C. tropicalis. The independent risk factors for candida infection were neutropenia, antibiotic duration >5 days, peritoneal dialysis, amino acid administration, mechanical ventilation, and presence of a central venous catheter (CVC).
How To Cite This Article:
Rajeshwari R, Vyasam S, Chandran J, Porwal S, Ebenezer K, Thokchom M, et al. Risk Factors for Candida Infection among Children Admitted to a Pediatric Intensive Care Unit in a Tertiary Care Centre in Southern India. Indian J Crit Care Med 2022;26(6):717-722.
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