Abstract 4735

Background

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.

Methods

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.

Results

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).

Table 1:

Oncologic Diagnosis

Oncologic DiagnosisControl (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 DiagnosisControl (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 
View Large
Conclusion

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.

Disclosures:

Zaoutis:Merck & Co.: Research Funding; Cephalon: Research Funding; Enzon: Research Funding.

Topics:
candidemia, pediatric oncology, graft-versus-host disease, aminoglycosides, acute lymphocytic leukemia, antibiotics, blood culture positive, bloodstream infections, central nervous system neoplasms, infections

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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