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Incidence, Classification, and Risk Stratification for Candida Central Line–Associated Bloodstream Infections in Pediatric Patients at a Tertiary Care Children's Hospital, 2000–2010

Published online by Cambridge University Press:  02 January 2015

J. Michael Klatte ,
Jason G. Newland  and
Mary Anne Jackson
J. Michael Klatte*
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics and University of Missouri–Kansas City, Missouri
Jason G. Newland
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics and University of Missouri–Kansas City, Missouri
Mary Anne Jackson
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics and University of Missouri–Kansas City, Missouri
*
Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108 (mklatte@cmh.edu)
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Abstract

Objective.

To identify risk factors for pediatric Candida central line-associated bloodstream infections (CLABSIs).

Design.

Retrospective case-control study.

Setting.

Freestanding tertiary care children's hospital.

Patients.

Patients with Candida CLABSI from January 31, 2000, through December 31, 2010, compared with age- and year-matched controls.

Methods.

Demographics, comorbidities, presence of indwelling foreign bodies, exposure to antibiotics or corticosteroids, total parenteral nutrition (TPN) or blood transfusions, complications, and outcome were evaluated. Bivariate and then logistic regression were used to compare temporal trends and risk factors.

Results.

A total of 160 Candida CLABSI patients (median age, 1.96 years) were compared with 457 controls. Those with Candida CLABSIs were more likely to have intestinal failure (adjusted odds ratio [aOR], 6.777 [95% confidence interval (CI), 2.315–19.839]; P < .001), to have a gastrostomy tube in place (aOR, 4.156 [95% CI, 2.317–7.456]; P < .001), and to receive TPN (aOR, 3.897 [95% CI, 2.403–6.319]; P < .001) or blood transfusions (aOR, 2.990 [95% CI, 1.841–4.856]; P < .001), and they had a 3-fold increase in mortality (aOR, 3.543 [95% CI, 1.501–8.364]; P = .004). Candida albicans was most common, but non-albicans strains resistant to amphotericin (C. lusitaniae) and fluconazole (C. glabrata and C. krusei) were also found.

Conclusions.

Those patients with intestinal failure, gastrostomy tube presence, and/or receipt of TPN and blood transfusions are at increased risk for development of Candida CLABSI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 12 , December 2013 , pp. 1266 - 1271
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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