Species-based comparison of disease severity and risk factors associated with disseminated Candida infections in pediatric patients
Background: Fungal infections such as Candida in pediatric patients are associated with worse clinical outcomes and increased costs, yet it is not definitively known if particular Candida species are associated with worse clinical outcomes than others. Differential risk factor exposures among the species group may also exist. This retrospective study of hospitalized pediatric patients at a large U.S. urban pediatric hospital aims to determine whether certain Candida species are more strongly associated with worse outcomes than others, as well as whether certain risk factors more strongly predispose patients to infection with certain Candida species. Methods: Microbiology lab records from patients seen from 2003-2010 at Children's Hospital of New Orleans, Louisiana, were reviewed to assemble a cohort of patients with invasive or disseminated Candida infections. Data on numerous measures of disease severity/outcome and risk factors were abstracted and analyzed to determine differences associated with various Candida species. Hospital patients’ length of stay and survival were also compared to those of a national patient sample from the corresponding years’ editions of the National Hospital Discharge Survey. Results: 106 cases of infection were analyzed. In general, differences among Candida species in terms of disease severity/outcome were insignificant. Nonalbicans species were associated with a significantly longer length of stay post diagnosis, as well as longer courses of treatment. C. albicans was associated with a higher number of antihypotensive medications required and length of mechanical ventilation postdiagnosis. C. tropicalis was associated with the highest mortality rate. In a multivariate model, borderline significantly higher risk for non-albicans infection was observed for patients receiving antifungal prophylaxis and longer than 96 hours mechanical ventilation. Higher risk for C. albicans infection was associated with antineoplastic chemotherapy. Longer lengths of stay and higher mortality rates were observed at the hospital studied compared to patients in the NHDS sample. Conclusion: Interspecies differences may exist for Candida in terms of disease severity and risk factors. Efforts to prevent infection should be tailored to the Candida species most likely to affect the pediatric subpopulation of interest, such as through targeted prophylaxis. Sound infection control practices are of critical importance in minimizing the impact of these infections.