1341. Risk Factors for Candidemia after Cardiac Surgery in Pediatric Patients with Congenital Heart Defects

Abstract

Abstract Background Candidemia is a serious complication in children with congenital heart defects (CHD) after cardiac surgery. Data on risk factors for postoperative candidemia in this high-risk population remains limited. This study aimed to identify the incidence, outcome, and risk factors for candidemia in this population. Methods This retrospective case-control study was carried out at two different pediatric intensive care units between 2004-2019. Candidemia cases were matched with control patients without candidemia. Univariate and multivariable logistic regression analyses were conducted to identify risk factors for postoperative candidemia. Results Overall, 105 patients were included. Thirty-five candidemia cases were matched to 70 control cases. The overall incidence of candidemia was 6.3/1000 admissions. The median age of candidemia cases was 4 months (range 16 days to 9.4 years). Crude 30-day mortality of candidemia cases was 43%. Risk factors independently associated with candidemia included cumulative antibiotic exposure for ≥4 days (OR 4.3, 95% CI 1.3-14.6; p =0.02), the need for total parenteral nutrition (TPN) or peritoneal dialysis (OR 6.1, 95% CI 2-18.8; p =0.001), male gender (OR 6.2, 95% CI 1.8-21.6, p=0.04) and delayed sternal closure ≥ 2 days (OR 3.2, 95% CI 1-11.2; p =0.05). The areas under the receiver operating characteristic curves for cumulative antibiotic exposure ≥ 4 days, the need for TPN or peritoneal dialysis, delayed sternal closure ≥ 2 days, male gender, and overall, were 0.74 (95% CI, 0.64-0.84), 0.75 (95% CI, 0.65-0.85), 0.65 (95% CI, 0.53-0.77), 0.65 (95% CI, 0.55-0.77) and 0.87 (95% CI, 0.81-0.94) respectively, which is for overall an excellent discrimination. Receiver Operating characteristic (ROC) curves for cumulative antibiotic exposure ≥ 4 days, the need for TPN or peritoneal dialysis, delayed sternal closure ≥ 2 days, male gender and overall Conclusion We found that postoperative candidemia in patients with CHD is an uncommon complication, occurring mostly in young infants. In our population, cumulative antibiotic exposure ≥ 4 days and the need for TPN or peritoneal dialysis were the strongest independent discriminative risk factors. However, adding previously unreported risks such as gender and delayed sternal closure strengthen the discrimination. Our results may help to define which patients with CHD should be given prophylactic or presumptive antifungal therapy. Disclosures All Authors: No reported disclosures.