Mortality associated with systemic candidiasis in children
Pacheco-Ríos, A.; Avila-Figueroa, C.; Nobigrot-Kleinman, D.; Santos, J.I.
Archives of Medical Research 28(2): 229-232
1997
ISSN/ISBN: 0188-4409 PMID: 9204614 Document Number: 475829
Factors associated with an increased risk of mortality due to systemic Candida infection in children hospitalized at a tertiary care facility in Mexico during January 1990-December 1991 were determined. 71 cases of Candida bloodstream infection were identified during the 2-year period. Candida spp. were identified in 31 children: C. albicans in 25, C. tropicalis in 3, and C. guilliermondii, C. krusei and C. glabrata [Torulopsis glabrata] in 1 each. The infection rate was 47 cases of candidaemia per 10 000 discharges and the case fatality rate was 46.5%. 61 cases occurred in infants under 2 years of age; 27 were newborns (38%). Using logistic regression analysis, the independent effects of potential risk factors for death due to candidaemia were evaluated. Three factors were associated with the subsequent risk for death due to systemic Candida infection: malnutrition (OR=4.3; 95% CI 1.2-14.8), prior surgery (OR=3.8; 95% CI 1.2-13.2) and the number of days between the first positive Candida blood culture and the onset of antifungal treatment (OR=1.12; 95% CI 1.06-1.25). Newborns showed an almost 3-fold greater risk of death due to candidaemia compared with other age groups, but this association was only marginally significant (OR =2.8; 95% CI 0.9-9.3). There was no difference in the rate of candidaemia between the 2 years of the study; however, the observed mortality declined significantly from 65% in year 1 to 20% in year 2 (P=0.02). It is concluded that the major finding of this study was to observe that for every day treatment was delayed the risk of death increased significantly. This study therefore provided support for empirical antifungal therapy early in the course of suspected systemic candidiasis in order to improve survival among children.