Candidemia in the pediatric patient with burns

Abstract

The incidence of candidemia in patients with burns appears to be falling. However, when it occurs it remains a significant cause of morbidity and a potential cause of death. A 5-year retrospective review revealed that 138 (14.4%) of 962 pediatric patients who had been acutely burned had Candida species isolated from one or more sites during their hospital stay, but candidemia developed in only 17 patients (12.3% of those from whom Candida species were recovered and 1.8% of all admissions). Patients from whom Candida species were recovered at one site had a 0% incidence of candidemia, those from whom Candida species were recovered at two sites had a 22.2% incidence of candidemia, and those from whom Candida species were recovered at three or more sites had a 34.4% incidence of candidemia. These differences were significant by chi-square analysis (p < 0.0001). There was a low mortality rate associated with candidemia, with only one (5.9%) of the 17 patients dying as a direct result of invasive Candida infection. Nystatin administered enterally did not prevent the development of candidemia. Our review suggests that delay in biologic wound closure and exposure to broad-spectrum antibiotics are associated with an enhanced risk of candidemia. Wound closure and systemically administered amphotericin B remain the mainstays of therapy.