Characteristics and risk factors of candidemia in pediatric intensive care unit of a tertiary care children's hospital in Egypt

  • Moustafa Hegazi Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
  • Alaa Abdelkader Mansoura University Children’s Hospital, Mansoura, Egypt
  • Maysaa Zaki Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • Basem El-Deek Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Keywords: Candida albicans, Candida non-albicans, candidemia risk factors, pediatric intensive care unit

Abstract

Introduction: This study was conducted to determine characteristics of Candida colonization and candidemia in the pediatric intensive care unit (PICU) of a tertiary care children's hospital.

Methodology: Patients between 6 months and 15 years of age consecutively admitted to the PICU of Mansoura University Children’s Hospital in Mansoura, Egypt, during one year period, were evaluated for Candida colonization and candidemia. Susceptibility of Candida species isolated from blood to fluconazole and amphotericin B was determined by Etest.

Results: Sixty-six patients without prior fluconazole prophylaxis had 88 episodes of candidemia, representing 19% of all cases with blood stream infections (BSIs).  Candida albicans (CA) and non-albicans Candida (NAC) species accounted for 40% and 60% of candidemia episodes respectively. C. parapsilosis, C. tropicalis, and C. glabrata accounted for 25%, 17%, and 8% of NAC candidemias respectively. Fluconazole resistance was detected in 11.4% and 18.9% of CA and NAC isolates respectively. Of the fluconazole resistant NAC isolates, four were C. krusei. Amphotericin B resistance was detected in 17% of NAC isolates. Candida colonization was detected in 78.8% of patients. Compared to CA candidemia, higher risk for NAC candidemia was associated with age older than 1 year, Candida isolation from endotracheal tube (ETT) and from central venous catheter. Mortality rate was 42.4%, attributable mortality of candidemia was 16.7%. Regression analysis showed that the most significant independent predictors of death were ETT and mechanical ventilation (MV), MV longer than 7 days, and candiduria.

Conclusions: This study presents important epidemiological features of Candida BSIs in a non-neonatal population.

Author Biographies

Moustafa Hegazi, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
Associate professor of pediatrics
Alaa Abdelkader, Mansoura University Children’s Hospital, Mansoura, Egypt
Associate professor of pediatrics
Maysaa Zaki, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Professor of clinical pathology
Basem El-Deek, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Professor of public health and community medicine
Published
2014-05-14
How to Cite
1.
Hegazi M, Abdelkader A, Zaki M, El-Deek B (2014) Characteristics and risk factors of candidemia in pediatric intensive care unit of a tertiary care children’s hospital in Egypt. J Infect Dev Ctries 8:624-634. doi: 10.3855/jidc.4186
Section
Original Articles