Mortality associated with systemic candidiasis in children

RESUMO

The purpose of this study was to determine factor asociated with an increased risk of mortality due to systemic Candida infections in children hospitalized at our tertiary care facility. A total of 71 cases of Candida bloodstream infections were identified over a 2-year period. The attack rate was 47 cases of candidemia per 10,000 discharges and the case fatality rate was 46.5 percent. Sixty-one cases occurred in infants under 2 years; 27 were newborns (38 percent). Using logistic regression analysis, we evaluated the independent effects of potential risk factors for death due to candidemia. Three factors were associated with the subsequent risk for death due to systemic candida infection malnutrition (OR=4.3; 95 percent CI 1.2-14.8), prior surgery (OR=3.8; 95 percent CI 1.2-13.2), and the number of days between the first positive candida blood culture and the onset of antifungal treatment (OR= 1.12; 95 percent CI 1.6-1.25). Newborns showed an almost three times greater risk of death due to candidemias as compared to other age groups, but this association was only marginally significant (OR= 2.8; 95 percent CI 0.9 - 9.3). There was no difference in the rate of candidemia between the 2 years of the study; however, the observed mortality declined significantly from 65 percent in year one to 20 percent in year two (p=0.02). The major finding of this study was to observe that for every day treatment was delayed the risk of death increased significantly. Thus, this study provides support for empirical antifungal therapy early in the course of suspected systemic candidiasis i order to improve survival among children