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Cited by 60Antifungal resistance and susceptibilityCentral Venous Catheters and HemodialysisInfective Endocarditis Diagnosis and Management

Analysis of independent risk factors for death among pediatric patients with candidemia and a central venous catheter in place

Pasqualotto, Alessandro C., de Moraes, Anaelena B., Zanini, Roselaine R., Severo, Luiz Carlos·2007·Infection Control & Hospital Epidemiology
DOI 10.1086/516658
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Abstract

Objective.: To use multivariate analysis to determine risk factors for death among pediatric patients with candidemia and a central venous catheter in place. Design.: Retrospective cohort study conducted at Santa Casa Complexo Hospitalar, a 1,200-bed teaching hospital in southern Brazil. Methods.: All cases of candidemia in pediatric patients (age, ≤ 13 years) at our medical center over a 9-year period were reviewed. A diagnosis of sepsis was required for inclusion in the study. Severity of illness was confirmed by the presence of hypotension requiring inotropes and according to the following scores: the Pediatric Risk of Mortality (PRISM) II score, the PRISM III score, and the Pediatric Logistic Organic Dysfunction score. The following 2 outcomes were evaluated: early death, defined as death occurring within 7 days after candidemia was diagnosed, and late death, defined as death 8-30 days after candidemia was diagnosed. Results.: A total of 61 patients were included in the study, including 14 neonates. Most (63.9%) of these patients were girls, and the median age was 0.3 years. A total of 80.3% of candidemia cases were due to species other than Candida albicans, primarily Candida parapsilosis (32.8% of cases) and Candida tropicalis (24.6% of cases). Using multivariate analysis, we demonstrated that failure to remove the central venous catheter was an independent risk factor for early death among pediatric patients with candidemia. However, patients whose catheters were retained were sicker than patients whose catheters were removed, and catheter removal had no impact on late death. Instead, severity of illness determined using the PRISM III score was also an independent predictor of late death. Conclusions.: Results from this study suggest that systematic removal of catheters from pediatric patients with candidemia does not reduce the occurrence of late death.

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  • Venous catheter infection and IC guidelines, including the current IDSA guidelines, recommend removal of any intravascular catheter that is positive for a fungal pathogen (i.e., Candida) based on evidence from large retrospective and observational studies.

    “Venous catheter infection and IC guidelines, including the current IDSA guidelines, recommend removal of any intravascular catheter that is positive for a fungal pathogen (ie, Candida) based on evidence from large retrospective and observational studies.”

    From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [173]

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Authors
Pasqualotto, A. C., de Moraes, A. B., Zanini, R. R., & Severo, L. C.
Affiliations
  • University of Manchester (GB)
  • Universidade Federal do Rio Grande do Sul (BR)
  • Santa Casa Hospital (BR)
Corresponding author
Pasqualotto, Alessandro C.
ORCID
Pasqualotto, Alessandro C.
Venue
Infection Control & Hospital Epidemiology
Publisher
Cambridge University Press (CUP)
Published
2007-07
Volume
28
Issue
7
Pages
799-804
ISSN
  • 0899-823X (ISSN-L)
  • 1559-6834
DOI
10.1086/516658
OpenAlex
W2144321114
Cited by
60
References
43
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 4 · 2015: 3 · 2014: 1 · 2013: 8 · 2012: 7
FWCI
3.57
Type
journal article
Language
en
Open access
closed
Licence
www.cambridge.org/core/terms (unspecified, 2742 d)
Locations
  • Infection Control and Hospital Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
Keywords
candidemia, pediatric patients, central venous catheters, catheter removal, mortality risk factors, sepsis, PRISM score, Candida parapsilosis, Candida tropicalis, early mortality, late mortality, disease severity
MeSH terms
Adolescent, Candidiasis, Catheterization, Central Venous, Child, Child, Preschool, Cross Infection, Female, Humans, Infant, Infant, Newborn, Male, Retrospective Studies, Risk Factors, Cohort Studies, Multivariate Analysis, Fungemia, Infection Control

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