Incidence, Classification, and Risk Stratification forCandidaCentral Line–Associated Bloodstream Infections in Pediatric Patients at a Tertiary Care Children's Hospital, 2000–2010

Abstract

Objective.To identify risk factors for pediatricCandidacentral line-associated bloodstream infections (CLABSIs).Design.Retrospective case-control study.Setting.Freestanding tertiary care children's hospital.Patients.Patients withCandidaCLABSI 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 160CandidaCLABSI patients (median age, 1.96 years) were compared with 457 controls. Those withCandidaCLABSIs 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 albicanswas most common, butnon-albicansstrains resistant to amphotericin (C. lusitaniae) and fluconazole (C. glabrataandC. 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 ofCandidaCLABSI.