Abstract
Abstract 4735
Candida species are among the most common causes of bloodstream infection and are associated with significant morbidity and mortality, particularly in oncology patients. Few studies have identified the risk factors for candidemia in pediatric oncology patients.
We conducted a nested case-control study within a cohort of pediatric patients admitted to the oncology unit at a children's hospital between 2001 and 2004. A case was defined as a patient with a positive blood culture for Candida spp. As time at risk is an important confounding variable in nosocomial studies assessing antibiotic risk factors, we selected two controls per case based on incidence-density sampling. Demographic and clinical data were collected by medical record review. Assessment of exposures was focused on the 2 weeks prior to the development of infection (case)/study entry (control). Conditional multivariate analyses were performed to determine independent risk factors for candidemia.
We identified 45 oncology patients with candidemia during the study period. The most commonly isolated species were C. albicans (49%), C. parapsilosis (18%), C. glabrata (9%), and C. lusitaniae (9%). The median age of cases was 6.2 years (Interquartile Range (IQR): 2.9– 13.8 years). Median time to candidemia was 12 days (IQR: 4-22 days). There was no significant difference in mortality between cases (7%) and controls (7%). Independent risk factors for candidemia included receipt of aminoglycosides for >3 days (OR: 10.51, CI: 2.96, 64.43), receipt of total parenteral nutrition (OR: 13.82, CI: 2.48, 44.49), and Graft versus Host Disease (GVHD) (OR: 15.09, CI: 0.91, 250.24).
Oncologic Diagnosis
| Oncologic Diagnosis . | Control (n = 90) . | Case (n = 45) . | p-value . |
|---|---|---|---|
| Solid tumor | 19 (21%) | 12 (27%) | REF |
| Acute myelogenous leukemia | 19 (21%) | 2 (4%) | 0.069 |
| Acute lymphoblastic leukemia | 33 (37%) | 9 (20%) | 0.093 |
| Neuroblastoma | 3 (3%) | 11 (25%) | 0.031 |
| Lymphoma | 8 (9%) | 0 (0%) | 0.992 |
| Central nervous system tumor | 2 (2%) | 6 (13%) | 0.231 |
| Other | 6 (7%) | 5 (11%) | 0.706 |
| Oncologic Diagnosis . | Control (n = 90) . | Case (n = 45) . | p-value . |
|---|---|---|---|
| Solid tumor | 19 (21%) | 12 (27%) | REF |
| Acute myelogenous leukemia | 19 (21%) | 2 (4%) | 0.069 |
| Acute lymphoblastic leukemia | 33 (37%) | 9 (20%) | 0.093 |
| Neuroblastoma | 3 (3%) | 11 (25%) | 0.031 |
| Lymphoma | 8 (9%) | 0 (0%) | 0.992 |
| Central nervous system tumor | 2 (2%) | 6 (13%) | 0.231 |
| Other | 6 (7%) | 5 (11%) | 0.706 |
The receipt of aminoglycosides for >3 days, use of TPN, and GVHD were independently associated with candidemia in pediatric oncology patients. These results may inform targeted interventions to reduce the risk of candidemia in pediatric oncology patients.
Zaoutis:Merck & Co.: Research Funding; Cephalon: Research Funding; Enzon: Research Funding.
Author notes
Asterisk with author names denotes non-ASH members.
