Many chronically or critically ill children suffer from blood infection with the fungus Candida (candidemia), which can result in death in up to 25 percent of children and 50 percent of infants. Children most likely to die from these infections are those who were in the pediatric intensive care unit (PICU) at the time of infection or who had an arterial catheter, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10399).
Researchers at the Center for Education and Research on Therapeutics (CERTs), University of Pennsylvania School of Medicine, and colleagues retrospectively studied hospitalized children with positive blood cultures for Candida species at one large hospital from 1998 through 2001. The research center is a part of the CERTs network supported by the Agency. They collected data on children's demographic and clinical characteristics, presence of coexisting conditions, antifungal treatment, infecting Candida species, and use of central venous and arterial catheters. They assessed in-hospital death within 30 days of initial positive culture for Candida.
Of a total 168 patients, 17 percent died within 1 month of the first positive culture for Candida. Children in the PICU at the time of infection were 6.3 times more likely to die within 30 days. Children who had an arterial line were 2.4 times more likely than those without a line to die within 30 days. Duration of catheter use and antifungal therapies (usually amphotericin B) during infection were not significantly associated with mortality. Newer triazole antifungals such as voriconazole and echinocandins and other newer antifungal agents may change the treatment strategies used to treat candidemia in children in the future.
See "Risk factors for mortality in children with candidemia," by Theoklis E. Zaoutis, M.D., Susan E. Coffin, M.D., M.P.H., Jaclyn H. Chu, M.H.S., and others in the August 2005 Pediatric Infectious Disease Journal 24(8), pp. 736-739.