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A 5-year analysis of Candida bloodstream infections in the paediatric cardiovascular surgery ICU of a tertiary care centre

Part of: Infectious

Published online by Cambridge University Press:  10 March 2022

Aysu Türkmen Karaağaç Open the ORCID record for Aysu Türkmen Karaağaç [Opens in a new window] ,
Ömer Faruk Şavluk  and
Ayşe İnci Yıldırım
Aysu Türkmen Karaağaç*
Affiliation:
Department of Peadiatrics, University of Health Sciences, Kartal Koşuyolu Research and Training Hospital, Istanbul, Turkey
Ömer Faruk Şavluk
Affiliation:
Anesthesiology and Reanimation Department, University of Health Sciences, Kartal Koşuyolu Research and Training Hospital, Istanbul, Turkey
Ayşe İnci Yıldırım
Affiliation:
Pediatric Cardiology, University of Health Sciences, Kartal Koşuyolu Research and Training Hospital, Istanbul, Turkey
*
Author for corrrespondence: A. T. Karaağaç, Department of Peadiatrics, University of Health Sciences Kartal Koşuyolu Research and Training Hospital, Denizer Cad, Cevizli Kavşağı, No: 2, 34846, Kartal, Istanbul, Turkey. Tel: 0(533)5679965; 0(216)5001500; Fax: 0(216)4596321. E-mail: aysukaraagac@gmail.com
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Abstract

Background:

Candida infections have become one of the most common causes of morbidity and mortality in paediatric ICUs, especially following complex surgeries, all over the world. Therefore, we conducted a 5-year analysis of Candida bloodstream infections in our tertiary paediatric cardiovascular surgery ICU.

Methods:

One thousand nine hundred and thirty four children, 0–16-year-old, who underwent paediatric cardiovascular surgery between January 2016–June 2021 were enrolled in this retrospective study. Blood cultures obtained from 1056 patients, who needed mechanical ventilation and indwelling devices longer than 5 days and had the signs of infection according to Center for Disease Control criteria, were evaluated. The isolated pathogens were recorded. 137 with Candida bloodstream infections were reanalysed for their age, weight, cardiac pathologies, duration of mechanical ventilation, hospitalisation and antibiotic use.

Results:

One hundred and thirty-seven out of one thousand and fifty six patients (12.9%) had Candida growth in their blood cultures. C. albicans (n: 50, 36.5%), C. parapsilosis (n: 20, 14.6%), C. tropicalis (n: 8, 5.8%), C. glabrata (n: 5, 3.7%), and other non-albicans Candida species (n: 54, 39.4%) were isolated. The patients with Candida bloodstream infections had lower age, longer duration of mechanical ventilation, longer length of hospital stay and antibiotic use (p-values<0.05). They had cardiac pathologies as atrioventricular septal defect (18.9%), transposition of great arteries (17.6%), tetralogy of Fallot (12.4%), transposition of great arteries + double outlet right ventricle, or total anomalous pulmonary venous return + atrioventricular septal defect (37.9%), and others. The Candida bloodstream infections mortality was 11.6% (16/137).

Conclusion:

The most common cause of Candida bloodstream infections in the last five years in our paediatric cardiovascular surgery ICU was non-albicans Candida species. Prolonged mechanical ventilation, hospitalisation and antibiotic use, low age, and weight were found as the main risk factors that raise the morbidity and mortality rates of Candida bloodstream infections.

Keywords

Candida bloodstream infectioncardiovascular surgeryICUpaediatry
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 2 , February 2023 , pp. 301 - 305
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Eggimann, P, Garbino, J, Pittet, D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis 2003; 3: 685–702. DOI 10.1016/S1473-3099(03)00801-6.CrossRefGoogle ScholarPubMed
Sievert, DM, Ricks, P, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention 2009-2010. Infect Control Hosp Epidemiol 2013; 34: 1–14. DOI 10.1086/668770.CrossRefGoogle Scholar
Wisplinghoff, H, Seifert, H, Tallent, SM, et al. Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features, and susceptibilities. Pediatr Infect Dis J 2003; 22: 686–691. DOI 10.1097/01.inf.0000078159.53132.40.CrossRefGoogle ScholarPubMed
Krcmery, V, Laho, L, Huttova, M, et al. Aetiology, antifungal susceptibility, risk factors and outcome in 201 fungaemic children: data from a 12-year prospective national study from Slovakia. J Med Microbiol 2002; 51: 110–116. DOI 10.1099/0022-1317-51-2-110.CrossRefGoogle ScholarPubMed
Ayık, MF, Atay, Y, Engin, Ç., et al. Nosocomial fungal infections after pediatric cardiac surgery. Turkish J Thorac Cardiovasc Surg 2006; 14: 208–211.Google Scholar
Dowell, SF, Peeling, RW, Boman, J, et al. Standardizing Chlamydia pneumonia assays: recommendations from the Centers for Disease Control and Prevention (USA) and the Laboratory Centre for Disease Control (Canada). Clin Infect Dis 2001; 33: 492–503. DOI 10.1086/322632.CrossRefGoogle ScholarPubMed
Mody, L, Krein, SL, Saint, SK, et al. A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial. JAMA Intern Med 2015; 175: 714–723. DOI 10.1001/jamainternmed.2015.132.CrossRefGoogle ScholarPubMed
Wisplinghoff, H, Bischoff, T, Tallent, SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39: 309–317. DOI 10.1086/421946.CrossRefGoogle ScholarPubMed
Tortorano, AM, Kibbler, C, Penman, J, et al. Candidaemia in Europe: epidemiology and resistance. Int J Antimicrob Agents 2006; 27: 359–366. DOI 10.1016/j.ijantimicag.2006.01.002.CrossRefGoogle ScholarPubMed
Lynn, LH, Duane, RH, Clinton, K, etal, M. Direct isolation of Candida spp. from blood cultures on the chromogenic medium CHROMagar Candida. J Clin Microbiol 2003; 41: 2629–2632. DOI 10.1128/JCM.41.6.2629-2632.2003.Google Scholar
Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 180–184. DOI 10.1053/j.pcsu.2004.02.009.CrossRefGoogle ScholarPubMed
Jaworski, R, Irga, N, Haponiuk, I, et al. Candidemia in children after complex congenital heart defects surgery treated with caspofungin-our own experience and a review of the literature. MedSciMonit 2011; 17: PH35–PH39. DOI 10.12659/MSM.881751.Google Scholar
Lim, CS, Rosli, R, Seow, HF, et al. Candida and invasive candidiasis: back to basics. Eur J Clin Microbiol Infect Dis 2012; 31: 21–31. DOI 10.1007/s10096-011-1273-3.CrossRefGoogle ScholarPubMed
Leon, C, Alverez-Lerma, F, Ruiz-Santana, S, et al. Fungal colonization and/or infection in non-neutropenic critically ill patients: results of the EPCAN observational study. Eur J Clin Microbiol Infect Dis 2009; 28: 233–242. DOI 10.1007/s10096-008-0618-z.CrossRefGoogle ScholarPubMed
Vincent, JL, Rello, J, Marshall, J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009; 302: 2323–2329. DOI 10.1001/jama.2009.1754.CrossRefGoogle Scholar
Kojic, EM, Darouiche, RO. Candida infections of medical devices. Clin Microbiol Rev 2004; 17: 255–267. DOI 10.1128/CMR.17.2.255-267.2004.CrossRefGoogle ScholarPubMed
Ram, G, Chinen, J. Infections and immunodeficiency in Down syndrome. Clin Exp Immunol 2011; 164: 9–16. DOI 10.1111/j.1365-2249.2011.04335.x.CrossRefGoogle ScholarPubMed
Chakrabarti, C, Sood, SK, Parnell, V, Rubin, LG. Prolonged candidemia in infants following surgery for congenital heart disease. Infect Control Hosp Epidemiol 2003; 24: 753–757. DOI 10.1086/502126.CrossRefGoogle ScholarPubMed
Garcia-San, ML, Cobo, J, Martos, I, et al. Risk factors for candidemia in pediatric patients with congenital heart disease. Infect Control Hosp Epidemiol 2006; 27: 576–580. DOI 10.1086/505094.Google Scholar
Mehta, Y, Gupta, A, Todi, S, et al. Guidelines for prevention of hospital acquired infections. Indian J Crit Care Med 2014; 18: 149–163. DOI 10.4103/0972-5229.128705.Google ScholarPubMed
Hope, WW, Castagnola, E, Groll, AH, et al. ESCMID (Society of Clinical Microbiology and Infectious Diseases) guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microbiol Infect 2012; 18: 38–52. DOI 10.1111/1469-0691.12040.CrossRefGoogle Scholar
Steinbach, WJ, Roilides, E, Berman, D, et al. Results from a prospective, international, epidemiologic study of invasive candidiasis in children and neonates. Pediatr Infect Dis J 2012; 31: 1252–1257. DOI 10.1097/INF.0b013e3182737427.CrossRefGoogle ScholarPubMed
Rex, JH, Walsh, TJ, Sobel, JD, et al. Practice guidelines for the treatment of candidiasis. Infectious Diseases Society of America. Clin Infect Dis 2000; 30: 662–678. DOI 10.1086/313749.CrossRefGoogle ScholarPubMed
Pappas, PG, Rex, JH, Lee, J, et al. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis 2003; 37: 634–643. DOI 10.1086/376906.CrossRefGoogle ScholarPubMed
Clancy, CJ, Nguyen, MH. Finding the "missing 50%" of invasive candidiasis: how nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis 2013; 56: 1284–1292. DOI 10.1093/cid/cit006.CrossRefGoogle ScholarPubMed
Lai, CC, Wang, CY, Liu, WL, et al. Time to positivity of blood cultures of different Candida species causing fungemia. J Med Microbiol 2012; 61: 701–704. DOI 10.1099/jmm.0.038166-0.CrossRefGoogle Scholar