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Candidemia in the pediatric patient with burns
R L Sheridan1, J M Weber, L G Budkevich
1Shriners Burns Institute, Boston, MA 02114, USA.
Abstract:
The incidence of candidemia in patients with burns appears to be falling. However, when it occurs it remains a significant cause of morbidity and a potential cause of death. A 5-year retrospective review revealed that 138 (14.4%) of 962 pediatric patients who had been acutely burned had Candida species isolated from one or more sites during their hospital stay, but candidemia developed in only 17 patients (12.3% of those from whom Candida species were recovered and 1.8% of all admissions). Patients from whom Candida species were recovered at one site had a 0% incidence of candidemia, those from whom Candida species were recovered at two sites had a 22.2% incidence of candidemia, and those from whom Candida species were recovered at three or more sites had a 34.4% incidence of candidemia. These differences were significant by chi-square analysis (p < 0.0001). There was a low mortality rate associated with candidemia, with only one (5.9%) of the 17 patients dying as a direct result of invasive Candida infection. Nystatin administered enterally did not prevent the development of candidemia. Our review suggests that delay in biologic wound closure and exposure to broad-spectrum antibiotics are associated with an enhanced risk of candidemia. Wound closure and systemically administered amphotericin B remain the mainstays of therapy.
Insights
Candidemia in pediatric burn patients is decreasing but remains serious. Risk increases with Candida recovery at multiple sites, highlighting the importance of wound closure and antifungal therapy.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pediatric Burn Care
Background:
- Candidemia poses a significant threat to patients with burns, impacting morbidity and mortality.
- While the overall incidence may be declining, invasive Candida infections remain a critical concern in this vulnerable population.
Purpose of the Study:
- To analyze the incidence, risk factors, and outcomes of candidemia in pediatric burn patients over a 5-year period.
- To evaluate the effectiveness of nystatin and identify key therapeutic strategies for managing candidemia in burn patients.
Main Methods:
- A retrospective review of 962 pediatric patients admitted with acute burns over five years.
- Analysis of Candida species recovery sites, incidence of candidemia, and patient outcomes, including mortality and treatment interventions.
Main Results:
- 14.4% of patients had Candida species isolated; candidemia occurred in 1.8% of all admissions.
- Incidence of candidemia significantly increased with the number of sites where Candida was recovered (0% for one site, 34.4% for three or more sites).
- Enteral nystatin was ineffective; wound closure and systemic amphotericin B were identified as primary therapies, with a low mortality rate of 5.9% for candidemia.
Conclusions:
- Delay in biologic wound closure and broad-spectrum antibiotic use are associated with increased candidemia risk.
- Prompt wound closure and systemic antifungal therapy, particularly amphotericin B, are crucial for managing candidemia in pediatric burn patients.