Abstract
This study was conducted to determine characteristics of Candida colonization and candidemia in the pediatric intensive care unit (PICU) of a tertiary care children's hospital. Patients between 6 months and 15 years of age consecutively admitted to the PICU of Mansoura University Children's Hospital in Mansoura, Egypt, during one year period, were evaluated for Candida colonization and candidemia. Susceptibility of Candida species isolated from blood to fluconazole and amphotericin B was determined by Etest. Sixty-six patients without prior fluconazole prophylaxis had 88 episodes of candidemia, representing 19% of all cases with blood stream infections (BSIs). Candida albicans (CA) and non-albicans Candida (NAC) species accounted for 40% and 60% of candidemia episodes respectively. C. parapsilosis, C. tropicalis, and C. glabrata accounted for 25%, 17%, and 8% of NAC candidemias respectively. Fluconazole resistance was detected in 11.4% and 18.9% of CA and NAC isolates respectively. Of the fluconazole resistant NAC isolates, four were C. krusei. Amphotericin B resistance was detected in 17% of NAC isolates. Candida colonization was detected in 78.8% of patients. Compared to CA candidemia, higher risk for NAC candidemia was associated with age older than 1 year, Candida isolation from endotracheal tube (ETT) and from central venous catheter. Mortality rate was 42.4%, attributable mortality of candidemia was 16.7%. Regression analysis showed that the most significant independent predictors of death were ETT and mechanical ventilation (MV), MV longer than 7 days, and candiduria. This study presents important epidemiological features of Candida BSIs in a non-neonatal population.
Highlights
This study was conducted to determine characteristics of Candida colonization and candidemia in the pediatric intensive care unit (PICU) of a tertiary care children's hospital
Considering that our study was not restricted to known specific high-risk groups, this relatively high incidence should be alarming for an emerging serious problem of candidemia at PICU arising as a consequence of management procedures which might have led to the well-known shift of candidaemia away from its former association with neutropenia into many other patient groups [21]
These findings are in accordance with the same increasing trend recorded in other studies where non-albicans Candida (NAC) blood stream infections (BSIs) were more prevalent than Candida albicans (CA) BSIs, with C.parapsilosis, C. tropicalis and C. glabrata being the most common NAC species causing infections in intensive care units [6,7]
Summary
This study was conducted to determine characteristics of Candida colonization and candidemia in the pediatric intensive care unit (PICU) of a tertiary care children's hospital. Susceptibility of Candida species isolated from blood to fluconazole and amphotericin B was determined by Etest. Results: Sixty-six patients without prior fluconazole prophylaxis had 88 episodes of candidemia, representing 19% of all cases with blood stream infections (BSIs). Fluconazole resistance was detected in 11.4% and 18.9% of CA and NAC isolates respectively. Compared to CA candidemia, higher risk for NAC candidemia was associated with age older than 1 year, Candida isolation from endotracheal tube (ETT) and from central venous catheter. An increasing role of non-albicans Candida (NAC) species, some of which are intrinsically or potentially resistant to antifungal agents, has been observed. NAC species, C. parapsilosis and C. tropicalis, account for almost half of invasive Candida infections in pediatric patients [4,5]. Nonalbicans Candida became more frequent causative agents for invasive fungal infections in the ICU with high transmission of C. parapsilosis [6,7,8]
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