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Mortality associated with systemic candidiasis in children
A Pacheco-Ríos1, C Avila-Figueroa, D Nobigrot-Kleinman
1Department of Infectious Diseases, Hospital Infantil de México, Federico Gómez, México, D.F.
Insights
Delayed antifungal treatment significantly increases mortality risk in children with systemic Candida infections. Early empirical therapy is crucial for improving survival rates in pediatric candidemia cases.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Systemic Candida infections (candidemia) pose a significant mortality risk in hospitalized children.
- Understanding risk factors for mortality is essential for timely and effective treatment strategies.
Purpose of the Study:
- To identify factors associated with increased mortality in children hospitalized with systemic Candida infections.
- To evaluate the impact of treatment delay on survival outcomes in pediatric candidemia.
Main Methods:
- Retrospective analysis of 71 pediatric cases of Candida bloodstream infections over a 2-year period.
- Logistic regression analysis was used to assess independent risk factors for death.
- Comparison of mortality rates between the two study years and different age groups.
Main Results:
- The overall case fatality rate for candidemia was 46.5%.
- Malnutrition (OR=4.3), prior surgery (OR=3.8), and delayed antifungal treatment (OR=1.12 per day) were independently associated with increased mortality.
- Mortality significantly decreased from 65% in year one to 20% in year two, coinciding with a potential shift in treatment practices.
Conclusions:
- Delayed initiation of antifungal treatment is a critical, modifiable risk factor for mortality in pediatric candidemia.
- Empirical antifungal therapy should be considered early in the management of suspected systemic candidiasis in children.
- These findings underscore the importance of prompt diagnosis and treatment to improve survival outcomes.
Abstract:
The purpose of this study was to determine factors associated with an increased risk of mortality due to systemic Candida infections in children hospitalized at our tertiary care facility. A total of 71 cases of Candida bloodstream infections were identified over a 2-year period. The attack rate was 47 cases of candidemia per 10,000 discharges and the case fatality rate was 46.5%. Sixty-one cases occurred in infants under 2 years; 27 were newborns (38%). Using logistic regression analysis, we evaluated the independent effects of potential risk factors for death due to candidemia. Three factors were associated with the subsequent risk for death due to systemic candida infection: malnutrition (OR = 4.3; 95% CI 1.2-14.8), prior surgery (OR = 3.8; 95% CI 1.2-13.2), and the number of days between the first positive candida blood culture and the onset of antifungal treatment (OR = 1.12; 95% CI 1.06-1.25). Newborns showed an almost three times greater risk of death due to candidemia as compared to other age groups, but this association was only marginally significant (OR = 2.8; 95% CI 0.9-9.3). There was no difference in the rate of candidemia between the 2 years of the study; however, the observed mortality declined significantly from 65% in year one to 20% in year two (p = 0.02). The major finding of this study was to observe that for every day treatment was delayed the risk of death increased significantly. Thus, this study provides support for empirical antifungal therapy early in the course of suspected systemic candidiasis in order to improve survival among children.