Incidence, classification, and risk stratification for Candida central line-associated bloodstream infections in pediatric patients at a tertiary care children's hospital, 2000-2010

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.