Related Experiment Videos
Risk factors for fungemia in children infected with human immunodeficiency virus: a case-control study
C E Gonzalez1, D Venzon, S Lee
1Infectious Diseases Section, National Cancer Institute Bethesda, Maryland 20892, USA.
Abstract:
To define the risk factors related to the occurrence of fungemia in children infected with human immunodeficiency virus (HIV), we performed a matched case-control study. During a 6-year period (1987-1993), fungemia developed in 22 (6.3%) of 347 HIV-infected children observed at the Pediatric Branch of the National Cancer Institute. Each of these 22 cases was matched by age and gender with three controls. Multiple logistic regression indicated that the best predictor of fungemia in this population was the presence of a central venous catheter placed for > 90 days (P < .00001), followed by a group of risk factors composed of 10 independent variables adjusted for a CD4 cell count of < 100/MicroL (P < .045). Those variables included treatment with more than three antibiotics, treatment with more than three parenteral antibiotics, > 30 days of antibiotic treatment, bacterial infections, > 30 days in the hospital, hypoalbuminemia, C3 (Centers for Disease Control and Prevention) classification of HIV infection, and malnourishment. We conclude that prolonged placement of central venous catheters is the most important risk factors for fungemia in HIV-infected children and that the risk of fungemia is further influenced by antibacterial therapy, catheter manipulation, and host response.
Insights
Prolonged central venous catheter use is the primary risk factor for fungemia in children with human immunodeficiency virus (HIV). Antibiotic therapy and hospital stay also increase fungemia risk.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Immunology
Background:
- Fungal infections, specifically fungemia, pose a significant threat to immunocompromised populations.
- Human immunodeficiency virus (HIV) infection in children weakens the immune system, increasing susceptibility to opportunistic infections like fungemia.
Purpose of the Study:
- To identify and define the key risk factors associated with the development of fungemia in pediatric patients diagnosed with HIV.
- To elucidate the specific clinical and therapeutic elements that predispose HIV-infected children to fungal bloodstream infections.
Main Methods:
- A matched case-control study design was employed over a six-year period (1987-1993).
- Twenty-two cases of fungemia in HIV-infected children were matched with three controls each, based on age and gender.
- Multiple logistic regression analysis was utilized to determine the most significant predictors of fungemia.
Main Results:
- The strongest predictor identified for fungemia was the presence of a central venous catheter in place for over 90 days (P < .00001).
- Additional significant risk factors, adjusted for a CD4 cell count below 100/MicroL, included extensive antibiotic use (more than three antibiotics, parenteral antibiotics, or >30 days of treatment), concurrent bacterial infections, prolonged hospitalization (>30 days), hypoalbuminemia, advanced HIV classification (C3), and malnutrition.
- These factors collectively contributed to an increased risk of fungemia.
Conclusions:
- Prolonged central venous catheterization is the paramount risk factor for fungemia in HIV-infected children.
- The risk of fungemia is further compounded by factors such as antibacterial therapy, manipulation of the catheter, and the host's immune response.