1064. Risk Factors for Mortality among Children with Candidemia
Session: Poster Abstract Session: Healthcare-Associated Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Candida species are among the most common causes of bloodstream infection and are associated with significant morbidity and mortality. There is a paucity of data on outcomes in children with candidemia.

Methods: Patients with blood cultures yielding Candida spp between 1997 and 2009 were identified at a children’s hospital.  A retrospective cohort study was conducted to identify risk factors for death among children with candidemia. The primary outcome of interest was 30 day in-hospital mortality. Demographic and clinical data were collected by medical record review. Assessment of exposures focused on the 2 weeks prior to development of infection. Multivariate analyses were performed to determine independent risk factors for death among patients with candidemia.

Results: We identified 406 patients with candidemia during the 13 year study period.  The most commonly isolated species were C. albicans(49%) and C.  parapsilosis(24%). The median age of patients was 2.7 years(Interquartile Range (IQR): 0.6– 10.8 years). The median time to candidemia from admission was 12 days (IQR: 3-25 days). Independent risk factors for 30 day in-hospital mortality among patients with candidemia included admission to the intensive care unit (ICU) at time of positive culture (odds ratio, OR, 10.31; 95% confidence interval, CI: 3.83, 27.70), presence of an arterial catheter within a week of infection (OR, 2.19, CI: 1.15, 4.18), and receipt of immunosuppressive agents in the 2 weeks prior to infection (OR, 1.19, CI: 1.01, 3.53). Patients who had catheters removed >72 hours after positive culture were not at greater risk of dying (p=0.435).  In addition, among patients who were alive 48 hours after positive blood culture, there was no difference in the time it took to start appropriate antifungal therapy between those who died and those who survived (p=0.490). 

Conclusion: To our knowledge, this is the largest study assessing outcomes in children with candidemia. Admission to the ICU, presence of an arterial catheter, and receipt of immunosuppressive agents were factors independently associated with death. These results will allow clinicians to identify patients at highest risk for poor outcomes and for whom targeted interventions to prevent candidemia should be applied.


Subject Category: P. Pediatric and perinatal infections

Priya Prasad, MPH1, Susan Coffin, MD, MPH1, A Russell Localio, JD, MS, PhD2, Louis Bell, MD1, Robert Gross, MD, MSCE2, Karin McGowan, PhD1, Thomas Walsh, MD, FIDSA3 and Theoklis Zaoutis, MD, MSCE1, (1)The Children's Hospital of Philadelphia, Philadelphia, PA, (2)The University of Pennsylvania, Philadelphia, PA, (3)National Cancer Institute, Bethesda, MD

Disclosures:

P. Prasad, None

S. Coffin, None

A. R. Localio, None

L. Bell, None

R. Gross, None

K. McGowan, None

T. Walsh, None

T. Zaoutis, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.