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Management and outcome of candida blood stream infections within a regional paediatric hospital
  1. B Wamola,
  2. R Mulholland,
  3. A Riordan
  1. Immunology and Infectious Diseases, Alderhey Children's NHS Foundation Trust, Liverpool, UK

Abstract

All positive blood cultures for Candida between April 2007 and April 2010 were identified from lab records We undertook a retrospective audit of hospital paper and electronic medical records. Data was analysed using Microsoft excel and compared to an Audit prior to the guidelines between January 2002 and April 2007.

The aims of the audit were to

  • To describe the demographic characteristics of patients.

  • To describe the underlying diagnosis and risk factors.

  • To ascertain if episodes were managed as per guidelines – removal of Central Venous Catheter (CVC), length of antifungal treatment and to describe morbidity (length of inpatient stay and complications) and mortality assoc with Candidemia.

We identified 34 episodes of Candidemia in 32 patients. Two patients had two episodes each while 30 patients had a single episode. 18 were male and 14 were female with age range 10 days to 17 years (Median 40 months, mean 60 months).

All patients had a CVC except one where the sample was sent post mortem therefore had possible hospital associated catheter related infections. All patients had prior. colonisation with Candida in routine surveillance cultures. 6 out of 34 episodes were assoc with neutropenia. Underlying diagnosis included malignancies, short gut/TPN dependent, complex heart disease and Prematurity.

Candida albicans formed 49% of isolates followed by Candida parapsilosis 24% and 19/34 (55.9%) episodes were treated for 14 days or more according to guidelines. 26/31 (84%) of patients had their CVC removed which was an improvement from 80% in the previous audit period. Amphotericin remained the most commonly prescribed antifungal used in 23/32 (72%) of patients.

Candida blood stream infections are associated with prolonged hospital stay, Paediatric Intensive Care admissions and significant cost (drugs, beds, staffing) 9/32 patients died with 5 patient deaths appearing to be related to the episode of Fungal sepsis.

This audit highlights the significant mortality and morbidity associated with candida bloodstream infections and the need for appropriate management in accordance with guidelines.

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