Evaluation of Risk Factors in Invasive Candida Infections in Children

Abstract

Objective: The aim of this study was to determine the distribution of Candida species isolated from children with Candida spp. growth in sterile body site cultures, the risk factors for invasive candidiasis, and the factors affecting mortality. Material and Methods: Patients with Candida spp. growth in sterile body region cultures in Clinic of Child Health and Diseases, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul Medeniyet University, pediatrics inpatient services and intensive care units between January 2017 and December 2018 were identified from mycology laboratory records, and patient information and epicrisis files were retrospectively analyzed. Demographic, microbiological and clinical data of the patients were recorded from mycology laboratory records and files. Results: In 63 (%55.5) patients C. albicans, in 15 (%13.27) patients C. glabrata and C. parapsilosis, in 14 (%12.39) patients C. tropicalis, in seven (%6.19) patients C. kefyr, in three (%2.15) patients C. krusei and (%0.88) C. guillermondii, C. lipolytica, C. lusitanie were found in one patient each. Of the patients, 91.1% had at least one risk factor. Length of hospitalization, underlying malignancy and immunodeficiency, cardiac failure, use of indwelling urinary and central venous catheters, total parenteral nutrition and nutrition, and dialysis were factors associated with mortality. It was observed that the use of antifungal treatment had a positive effect on survival. It was found that in those with C. parapsilosis growth, the age group was younger, the duration of hospitalization, staying on mechanical ventilator, using broad-spectrum antibiotics was longer, and receiving antifungal treatment for a longer period of time, and it was found to be statistically significant. It was observed that C. albicans was higher in patients hospitalized in the pediatric intensive care unit, and C. parapsilosis was higher in patients hospitalized in the neonatal intensive care unit. In terms of risk factors, C. albicans was associated with immunodeficiency and the use of broad-spectrum antibiotics, while C. parapsilosis was associated with the presence of surgical intervention, Candida colonization, chronic lung disease, permanent urinary and central venous catheter use, and lack of enteral nutrition. The relation between both species and mortality was not statistically significant. Conclusion: In conclusion, although C. albicans is still the most common cause in children with invasive candidiasis in our hospital, the rate of increase in non-albicans species was found to be higher in the two-year period. Length of hospitalization, underlying malignancy and immunodeficiency, cardiac insufficiency, use of indwelling urinary and central venous catheters, total parenteral nutrition ( TPN), nutrition and dialysis are factors associated with mortality. Knowledge of local epidemiological data and risk factors in invasive Candida infections is very important for empirical treatment.