In-hospital Outcome and Main Determinants of Candida Septicemia in Children Admitted to Neonatal and Pediatric Intensive Care Units

Background and Objective: Identifying main risk profile of candidiasis in children provides favorable condition to effectively deal with disease and to prevent its complications. The present study aimed to determine main risk factors for candida septicemia in children admitted to a referral center for infectious diseases in children. Methods: This case-control study was performed on 48 consecutive children with positive blood culture for candida infection. A sex- and age-matched group including 52 children hospitalized without diagnosis of candidiasis was selected as the control. The baseline characteristics and clinical data of children were collected from the hospital files and recorded at the study checklists. Findings: Regarding underlying disorders, the prevalence of pneumonia was significantly higher in the group with candida septicemia than in another group (20.0% versus 2.3%, p < 0.001), but there was no difference in the prevalence of other underlying diseases including esophageal atresia, NEC, RDS and sepsis. There was also no difference between the case and control groups in the prevalence of clinical risk factors for fungal infection including preterm labor, low birth weight, mechanical ventilation, GVHD, central venous catheter, arterial catheter, urinary catheter and nasogastric tube. Also, no difference was revealed between the groups in terms of needing dialysis, receiving immunosuppressive medications, receiving antibiotics and lumbar puncture. In total, the use of antibiotics was significantly reported more in the group with positive blood culture for fungal infection than control group. Also, those with positive blood culture for candida received more anti-fungal therapy than those without positive candida infection at present (73.1% versus 8.3%, p < 0.001). In total, in-hospital mortality was more frequent among children with positive blood culture for candida than the control group (36.5% versus 10.4%, p =0.002). However, the length of hospital stay did not differ between the two groups (46.3 ± 4.5 days versus 44.8% versus 7.8 days, p = 0.872). Conclusion: We could find simultaneous occurrence of pneumonia and prolonged stay in hospital as the main correlates of candida septicemia. About one-third of affected children with candidiasis die within hospitalization that is near to reported global range. Occurring candida septicemia leads to high rate of in-hospital mortality, but it may not be accompanied with prolonged hospital stay