Candida Bloodstream Infections and Associated Risk Factors in Pediatric Cardiac Intensive Care

Abstract

Background: Candida infections have become a significant cause of morbidity and mortality in pediatric cardiac intensive care units following congenital heart surgery, ranking among the most common causes of complications in this patient population. There is a paucity of information available regarding the epidemiology, clinical features, and risk factors associated with candidemia in this patient population. The present study evaluates the incidence of Candida bloodstream infections in pediatric cardiac intensive care units. Methods: The study was conducted retrospectively on cases of patients under the age of 18 who were admitted to the pediatric cardiac intensive care unit between 1 January 2021 and 1 January 2024. The isolated pathogens were recorded. A reanalysis was conducted on 36 patients with Candida bloodstream infections, with data pertaining to age, weight, cardiac pathologies, duration of mechanical ventilation, length of hospital stay, and antibiotic use being subjected to further examination. Each case was matched with two control patients based on age and date of surgery. The results were analyzed statistically. Results: A total of 36 cases of candidemia were identified and matched with 72 control cases. The incidence of candidemia was found to be 21.8 episodes per 1000 hospital admissions. The median age of patients with candidemia was four months. Candida species were identified in the blood cultures of 36 out of 1650 patients (0.21%). Candida albicans (n = 12, 33.3%), Candida parapsilosis (n = 16, 44.4%), Candida glabrata (n = 2, 5.5%), and other non-albicans Candida species (n = 6, 16.6%) were isolated. The mortality rate associated with Candida bloodstream infections was 61.1% (22/36). The following independent risk factors were identified as being associated with candidemia: a birth weight of less than 2500 g (OR: 3.2; 95% confidence interval (CI): 2.5-5; p = 0.009), a RACHS-1 score of 4 or above (OR: 2.1; 95% CI: 1.3-6; p = 0.01), cumulative antibiotic exposure of seven days or more (OR: 2.5; 95% CI: 2-10; p < 0.001), duration of central venous catheterization (CVC) of ≥14 days (OR: 6.1; 95% CI: 4-18; p < 0.001), mechanical ventilation dependency of ≥10 days (OR: 4.2; 95% CI: 3-11; p = 0.01), a requirement for total parenteral nutrition (OR: 9; 95% CI: 6-24; p < 0.001), and delayed sternal closure of ≥2 days (OR: 1.8; 95% CI: 1-4; p = 0.04). Conclusions: Postoperative candidemia represents a significant complication in pediatric patients with congenital heart disease (CHD), with different Candida species identified as a potential cause. The primary risk factors that contribute to the likelihood of a Candida bloodstream infection in these cases are a low birth weight, a high RACHS-1 score, dependence on mechanical ventilation, prolonged exposure to antibiotics, prolonged central venous catheter duration, delayed sternal closure, and total parenteral nutrition.

Keywords: candidemia; congenital heart disease; intensive care unit.

Figure 1

Distribution of Candida species in bloodstream infections.