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Prolonged Candidemia in Infants Following Surgery for Congenital Heart Disease

Published online by Cambridge University Press:  02 January 2015

Chandrama Chakrabarti ,
Sunil K. Sood ,
Vincent Parnell  and
Lorry G. Rubin
Chandrama Chakrabarti
Affiliation:
Department of Pediatrics, Schneider Children's Hospital, New Hyde Park, andNorth Shore University Hospital, North Shore-Long Island Jewish Health System, Manhasset, New York
Sunil K. Sood
Affiliation:
Department of Pediatrics, Schneider Children's Hospital, New Hyde Park, andNorth Shore University Hospital, North Shore-Long Island Jewish Health System, Manhasset, New York
Vincent Parnell
Affiliation:
Department of Cardiothoracic Surgery, Schneider Children's Hospital, New Hyde Park, andNorth Shore University Hospital, North Shore-Long Island Jewish Health System, Manhasset, New York
Lorry G. Rubin*
Affiliation:
Department of Pediatrics, Schneider Children's Hospital, New Hyde Park, andNorth Shore University Hospital, North Shore-Long Island Jewish Health System, Manhasset, New York
*
Schneider Children's Hospital, 269-01 76th Avenue, New Hyde Park, NY 11040
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Abstract

Objectives:

To describe a group of infants with complex congenital heart disease (CCHD) who had candidemia postoperatively and to perform a case–control study of risk factors.

Design:

Descriptive and case–control study.

Setting:

Tertiary-care medical centers.

Patients:

Infants with CCHD who underwent cardiac surgery and developed candidemia. Controls were matched for congenital heart disease lesions, age, and postoperative hospital stay.

Results:

Of 95 infants younger than 6 months with CCHD who underwent cardiac surgery between January 1999 and April 2001, 6 (6.3%) developed candidemia with 5 different species. The candidemia was prolonged (range, 12 to 32 days; median, 17 days). The interval between cardiac surgery and onset of candidemia was 12 to 57 days (median, 24 days). All had a central venous catheter inserted 8 to 50 days prior to the onset of candidemia. The mortality rate was 83%, compared with 13% for the group without candidemia. A univariate analysis of the potential risk factors revealed that duration of total parenteral nutrition (TPN), duration of antibiotics, intraoperative cardiopulmonary bypass time, and documentation of an intravascular thrombus were associated with candidemia. In multivariate analysis, long duration of TPN and documentation of a thrombus were associated with candidemia.

Conclusions:

Candidemia following cardiac surgery for infants with CCHD was persistent and associated with high mortality. The variety of species indicates that this was not a common-source outbreak. Risk factors associated with candidemia were duration of TPN and documentation of an intravascular thrombus.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 10 , October 2003 , pp. 753 - 757
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Jarvis, WR. Epidemiology of nosocomial fungal infections with Candida species. Clin Infect Dis 1995;20:1526–1530.Google Scholar
2.Levy, I, Rubin, L, Vasishtha, S, Tucci, V, Sood, S. Emergence of Candida parapsilosis as the predominant species causing candidemia in children. Clin Infect Dis 1998;26:1086–1088.CrossRefGoogle ScholarPubMed
3.Fraser, VJ, Jones, M, Dunkil, J, Storfer, S, Medoff, G, Dungan, W. Candidemia in a tertiary care hospital: epidemiology, risk factors, predictors of mortality. Clin Infect Dis 1992;15:414–421.CrossRefGoogle Scholar
4.Edwards, J. International conference for the development of a consensus on the management and prevention of Candida infections. Clin Infect Dis 1997;25:43–59.Google Scholar
5.Benoit, D, Decruyenaire, J, Vandewoude, K, et al.Management of Candida thrombophlebitis of the central veins: case report and review. Clin Infect Dis 1998;26:393–397.CrossRefGoogle ScholarPubMed
6.Stamos, JK, Rowley, A. Candidemia in a pediatric population. Clin Infect Dis 1995;20:571–575.Google Scholar
7.Weesemayer, D, Fondriest, W, Brouillette, R, Shulman, S. Risk factors associated with candidemia in the neonatal intensive care unit: a case control study. Pediatr Infect Dis J 1987;6:190–196.Google Scholar
8.Strinden, WD, Helgerson, RB, Maki, DG. Candida septic thrombosis of the great central veins associated with central catheters. Ann Surg 1985;202;653–658.Google Scholar
9.Ashkenazi, S, Pickering, L, Robinson, L. Diagnosis and management of septic thrombosis of the inferior vena cava caused by Candida tropicalis. Pediatr Infect Dis J 1990;9:446–447.Google Scholar
10.Wiley, E, Hutchins, G. Superior vena cava syndrome secondary to Candida thrombophlebitis complicating parenteral alimentation. J Pediatr 1977;91:977–979.CrossRefGoogle ScholarPubMed
11.Paige, C, Pinson, W C, Antonovic, R, Strassbough, L. Catheter related thrombophlebitis of the superior vena cava caused by C. glabrata. West J Med 1987;147:333–335.Google Scholar
12.Garcia, E, Granier, I, Geissler, A, et al.Surgical management of Candida suppurative thrombophlebitis of superior vena cava after central venous catheterization. Intensive Care Med 1997;23:1002–1004.Google Scholar
13.Rupar, D, Herzog, K, Fisher, M, Long, S. Prolonged bacteremia with catheter related central venous thrombosis. American Journal of Diseases in Childhood 1990;144:879–882.Google Scholar
14.Mollitt, DL, Golladay, ES. Complications of TPN catheter induced vena cavai thrombosis in children less than 1 year of age. J Pediatr Surg 1982;18;462–467.Google Scholar
15.Sadiq, HF, Devaskar, S, Keenan, EJ, et al.Broviac catheterization in low birth weight infants: incidence and treatment of associated complications. Crit Care Med 1987;15:47–50.Google Scholar
16.Curry, CR, Quie, PG. Fungal septicemia in patients receiving parenteral hyperalimentation. N Engl J Med 1971;285:1221–1224.CrossRefGoogle ScholarPubMed
17.Anaissie, E, Darouiche, R, Abisaid, D, et al.Management of invasive candidal infections: results of a prospective, randomized, multicenter study of fluconazole versus amphotericin B and review of literature. Clin Infect Dis 1996;23:964–972.Google Scholar
18.Gupta, A, Leaker, M, Andrew, M, et al.Safety and outcomes of thrombolysis with tissue plasminogen activator for treatment of intravascular thrombosis in children. J Pediatr 2001;139:682–688.CrossRefGoogle ScholarPubMed
19.Lacey, S, Zaritsky, A, Aziz Khan, R. Successful treatment of Candida infected cavai thrombosis in critically ill infants by low dose streptokinase infusion. J Pediatr Surg 1988;23:1204–1209.Google Scholar
20.Johnson, DE, Thompson, TR, Green, TP, et al.Systemic candidiasis in very low birth weight infants. Pediatrics 1984;73:138–143.Google Scholar