Program Schedule

1449
Clinical Prediction Model for Candidemia in Pediatric ICU Patients: Failure to Validate

Session: Poster Abstract Session: Fungal Infections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Candidemia is associated with significant morbidity and mortality and pediatric intensive care unit (PICU) patients with candidemia are at particular high risk for death. A clinical prediction rule for early detection of candidemia in the PICU was previously derived at a single center. Multi-center validation is necessary prior to routine application.

 

Methods:

Patients <19 years of age with candidemia were identified prospectively from six pediatric institutions (1/1/2005 - 12/31/2009). Cases were matched to two controls in the same PICU by incidence density sampling. Conditional logistic regression was performed to evaluate the association of candidemia with the previously derived predictor variables.

Results:

Ninety-six patients with candidemia were identified with a median age of 4 years (range 43 days to 18 years) and matched to similar controls. The proportion of predictors of candidemia for cases and controls varied significantly by study site (table) and only the presence of a central venous catheter was associated with candidemia (OR: 9.6; 95% CI: 3.4-27.3).

Conclusion:

Our multi-center study did not validate the previously derived prediction rule due to significant variability in predictors across hospitals and time. Consideration should be given to including biomarkers in future prediction rules.

Brian Fisher, DO, MPH, MSCE1,2, Rachael Ross, MPH1, Emmanuel Roilides, MD, PhD3, Debra Palazzi4, Mark Abzug, MD5, Jill Hoffman, MD6, David Berman7, Priya Prasad, MPH1, Russell Localio, PhD8, William Steinbach, MD, FAAP, FIDSA9, Lambrini Vogiatzi10, Ankhi Dutta11 and Theoklis Zaoutis, MD, MSCE12, (1)The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Center for Clinical Epidemiology & Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (3)Aristotle University, Thessaloniki, Greece, (4)Baylor College of Medicine, Houston, TX, (5)University of Colorado School of Medicine, Aurora, CO, (6)Children's Hospital, Los Angeles, Los Angeles, CA, (7)All Children's Hospital, St Petersburg, FL, (8)University of Pennsylvania, Philadelphia, PA, (9)Duke University Medical Center, Durham, NC, (10)Hippokration General Hospital, Thessaloniki, Greece, (11)Baylor College of Medicine, College Station, TX, (12)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, the Children's Hospital of Philadelphia, Philadelphia, PA, The Children's Hospital of Philadelphia, Philadelphia, PA

Disclosures:

B. Fisher, None

R. Ross, None

E. Roilides, None

D. Palazzi, None

M. Abzug, None

J. Hoffman, None

D. Berman, None

P. Prasad, None

R. Localio, None

W. Steinbach, None

L. Vogiatzi, None

A. Dutta, None

T. Zaoutis, Merck: Investigator, Research grant
Merck: Consultant, Consulting fee
Pfizer: Consultant, Consulting fee
Astellas: Consultant, Consulting fee

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