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Risk Factors for Candidemia in Pediatric Patients With Congenital Heart Disease

  • Lucía García-San Miguel (a1), Javier Cobo (a1), Isabel Martos (a2), Enrique Otheo (a2), Alfonso Muriel (a3), Vicente Pintado (a1) and Santiago Moreno (a1)...



To identify the main risk factors for the acquisition of candidemia in children with congenital heart disease (CHD) in order to improve the clinical management of these patients.


A case-control study.


A large tertiary-care referral center in Spain with a pediatric intensive care unit (PICU) to which more than 500 children with CHD are admitted annually.


All patients had CHD and were admitted to the PICU during 1995-2000. Case patients were defined as patients with candidemia, and control patients were defined as patients without candidemia.


Twenty-eight case patients and 47 control subjects were included in the study. Case patients were younger (mean age [ ± SD], 12.5 ± 32.0 vs 38.0 ± 48.0 months; P< .01) and had a longer median PICU stay (19 vs 4 days; P < .01), and a greater percentage of case patients previously had Candida species isolated from specimens other than blood (eg, bronchial aspirates, urine, or skin specimens) (39% vs 4%; P<.01). Severity of clinical condition, as measured by the Therapeutic Intervention Scoring System (TISS) 1 week after PICU admission (odds ratio, 1.15; 95% confidence interval, 1.05-1.26; P<.01), and receipt of antibiotic treatment for more than 5 days (odds ratio, 13.42; 95% confidence interval, 1.31-137.13; P = .03) were independently associated with the development of candidemia.


Patients with CHD who have a high TISS score 1 week after PICU admission and patients who have received prolonged antibiotic therapy should be considered at high risk for candidemia. Our results suggest that shorter courses of antibiotic therapy, routine surveillance culture for Candida species, and initiation of preemptive or empirical antifungal treatment could help in the clinical management of these patients.


Corresponding author

Hospital Ramón y Cajal, Servicio de Enfermedades Infecciosas, Carretera de Colmenar Km 9,100, Madrid 28034, Spain (


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1.Beck Sague, C, Jarvis, WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. National Nosocomial Infections Surveillance System. J Infect Dis 1993; 167:12471251.
2.García-San Miguel, L, Pla, J, Cobo, J, Navarro, F, Sánchez-Sousa, A, Alvarez, ME, Martos, I, Moreno, S. Morphotypic and genotypic characterization of sequential C. parapsilosis isolates from an outbreak in a pediatric intensive care unit. Diagn Microbiol Infect Dis 2004; 49:189196.
3.Kossoff, EH, Buescher, ES, Karlowicz, MG. Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases. Pediatr Infect Dis J 1998; 17:504508.
4.Rennert, G, Rennert, HS, Pitlik, S, Finkelstein, R, Kitzes-Cohen, R. Epidemiology of candidemia: a nationwide survey in Israel. Infection 2000; 28:2629.
5.Saiman, L, Ludington, E, Pfaller, M, et al. Risk factors for candidemia in neonatal intensive care unit patients. The National Epidemiology of Mycosis Survey Study Group. Pediatr Infect Dis J 2000; 19:319324.
6.García-San Miguel, L, Cobo, J, Otheo, E, Sánchez-Sousa, A, Abraira, V, Moreno, S. Secular trends of candidemia in a large tertiary hospital (19882000): the emergence of C. parapsilosis. Infect Control Hosp Epidemiol 2005; 26:548552.
7.Jarvis, WR. Epidemiology of nosocomial fungal infections, with emphasis on Candida species. Clin Infect Dis 1995; 20:15261530.
8.Stamos, JK, Rowley, AH. Candidemia in a pediatric population. Clin Infect Dis 1995; 20:571575.
9.Chakrabarti, C, Sood, SK, Parnell, V, Rubin, LG. Prolonged candidemia in infants following surgery for congenital heart disease. Infect Control Hosp Epidemiol 2003; 24:753757.
10.Keene, AR, Cullen, DJ. Therapeutic Intervention Scoring System: update 1983. Crit Care Med 1983; 11:13.
11.Pollack, MM, Ruttimann, UE, Getson, PR. Pediatric Risk of Mortality (PRISM) score. Crit Care Med 1988; 16:11101116.
12.Dugan, C. Nutritional assessment and requirements. In: Walter, WA, Durie, PR, Hamilton, JR, Walter-Smith, JA, Watkins, JB, eds. Pediatric Gastrointestinal Disease. 3rd ed. Hamilton, Canada: BC Decker; 2000:16911705.
13.Voss, A, Hollis, RJ, Pfaller, MA, Wenzel, RP, Doebbeling, BN. Investigation of the sequence of colonization and candidemia in nonneutropenic patients. J Clin Microbiol 1994; 32:975980.
14.Bonten, MJM, Gaillard, CA, Johanson, WG, et al. Colonization in patients receiving and not receiving topical antimicrobial prophylaxis. Am J Respir Crit Care Med 1994; 150:13321340.
15.Martino, P, Girmenia, C, Micozzi, A, De Bernardis, F, Boccanera, M, Cassone, A. Prospective study of Candida colonization, use of empiric amphotericin B and development of invasive mycosis in neutropenic patients. Eur J Clin Microbiol Infect Dis 1994; 13:797804.
16.Abraira, V, Pérez de Vargas, A. Método Multivariante en Bioestadtstíca. Madrid: Editorial Centra de Estudios Ramón Areces; 1996.
17.Fraser, VJ, Jones, M, Dunkel, J, Storfer, S, Medoff, G, Dunagan, WC. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis 1992; 15:414421.
18.Harvey, RL, Myers, JP. Nosocomial fungemia in a large community teaching hospital. Arch Intern Med 1987; 147:21172120.
19.Horn, R, Wong, B, Kiehn, TE, Armstrong, D. Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy. Rev Infect Dis 1985; 7:646655.
20.Komshian, SV, Uwaydah, AK, Sobel, JD, Crane, LR. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome. Rev Infect Dis 1989; 11:379390.
21.Levy, I, Rubin, LG, Vasishtha, S, Tucci, V, Sood, SK. Emergence of Candida parapsilosis as the predominant species causing candidemia in children. Clin Infect Dis 1998; 26:10861088.
22.MacDonald, L, Baker, C, Chenoweth, C. Risk factors for candidemia in a children's hospital. Clin Infect Dis 1998; 26:642645.
23.Micek, ST, Ward, S, Fraser, VS, Kollef, MH. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest 2004; 125:17911799.


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