CANDIDA ASSOCIATED BLOODSTREAM INFECTIONS IN PEDIATRIC HEMATOLOGY PATIENTS: SINGLE CENTER EXPERIENCE

Abstract

Background and Objectives: Candida-associated bloodstream infections are frequent and potentially life-threatening conditions in hematology patients. The aim of this study is to evaluate the characteristics, risk factors, and outcome of Candida-associated bloodstream infections in children with hematological diseases at a children’s hospital. Methods: The medical records of the patients with hematological diseases and hematopoietic stem cell transplantation (HSCT) recipients who were diagnosed as Candida-associated bloodstream infection between February 2010 and February 2014 were reviewed retrospectively. Results: Thirty episodes of candidemia involving 26 patients (38% female, and 62% male) with median age of 7 years (range; 1 to 17) were noted. Infections with non-albicans Candida spp. occurred more frequently (63%) and C. krusei was the predominant microorganism among non-albicans Candida spp. (37%). Candida albicans was isolated from 11 of the 30 episodes (37%). Twenty-three of the patients (88%) had central venous catheter (CVC) prior to candidemia, and they were removed in 16 of the 30 episodes (53%). Isolated Candida spp, underlying disease and status of the disease, presence of mucositis, neutropenia, using of broad spectrum antibiotics, corticosteroids or total parenteral nutrition were not identified as predictors of outcome. However patients whose CVCs had not been removed were more likely to die than those whose had been removed (54% vs. 6%, respectively; p=0.012). Conclusions: Candida-associated bloodstream infections in children with hematological diseases and HSCT recipients were common particularly in patients with CVCs. Beside appropriate antifungal therapy, CVC removal improves the outcome of candidemia in children with hematological disease.

Keywords

• Fungal infection
• neutropenia
• leukemia