Children's Health

Prolonged Candida infections in children with central venous catheters can lead to bloodstream and internal organ infections

Infections caused by Candida, a yeast-like fungus, are the fourth most common cause of hospital-induced bloodstream infections in the United States. This is a serious problem, since the infection can then spread to critical organs, perhaps leading to organ failure and death. Hospitalized children with central venous catheters in place who have a Candida infection lasting more than 3 days or who have suppressed immune systems are three times as likely as other children to develop bloodstream infection with Candida that affects internal organs, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10399).

To determine the risk factors for bloodstream infection with Candida (candidemia) spreading to internal organs (disseminated candidiasis), the researchers compared characteristics of hospitalized children with candidemia determined from hospital laboratory records from 1998 through 2001, whose infections spread or did not spread to internal organs. Of the 168 children with Candida bloodstream infections identified, 10 children had recurrent bloodstream infections. Of the 153 children included in the analysis of risk factors for disseminated candidiasis, 17 percent had evidence of probable disseminated candidiasis.

More than 3 days of positive blood cultures for Candida in children with a central venous catheter in place and immunosuppression both tripled the likelihood of organs becoming infected. Common organs affected included the lung (58 percent), liver (23 percent), kidney (16 percent), brain (12 percent), spleen (8 percent), eye (8 percent), and heart (8 percent). Nearly one-third (31 percent) of the children had more than one organ affected. The researchers call for future studies to determine the extent of evaluation needed for detecting dissemination among children with candidemia and to explore interventions for its prevention.

See "Risk factors for disseminated candidiasis in children with candidemia," by Theoklis E. Zaoutis, M.D., H. Mollie Greves, M.D., Ebbing Lautenbach, M.D., M.P.H., M.S.C.E., and others, in the July 2004 Pediatric Infectious Disease Journal 23(7), pp. 635-641.

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