Prediction of candidemia in pediatric patients based on central venous catheter: Real world evidence to guide antifungal empirical prescription
DOI:
https://doi.org/10.33448/rsd-v13i4.44508Keywords:
Candidemia; Antifungal agents; Central venous catheterization; Hospitals, Pediatric.Abstract
Background: Candida is one of the main etiological agents of bloodstream nosocomial infections, and is associated with high morbidity/mortality in children. High use of empirical antifungals incurs in higher health care costs and concerns on emergent resistant Candida spp. Therefore, a prediction model should optimize prescribing empirical antifungals in pediatrics. Objective: Based on real-world evidence data, we aimed at assessing how accurate is a regression model for predicting central venous catheter (CVC) candidemia in pediatric patients. We also explored how this prediction model might be useful for prescribing antifungals empirically. Methods: A case-control study was conducted based on 144 patients with positive and negative blood cultures for Candida spp.. A model for predicting Candida spp. was developed through univariate and multivariate analyses (logistic regression). Data were reported as odds ratio (OR) and p-value less than 0.05 was considered statistically significant. Results: Candidemia was predicted by the presence of CVC (OR 2.561, p=0.0042). For this model, an area under the curve (AUC) of 0.550 (p=0.314) was estimated, representing the Receiver Operating Characteristic curve of the present study, with a sensitivity of 86% and a specificity of 24%. Conclusion: Our study demonstrated that CVC is a fragile predictor for candidemia, however, its clinical significance and low specificity obtained in the ROC curve suggests that other covariates rather than those investigated should be considered to assess its impact on a prediction model for pediatric patients.
References
Ahangarkani, F., Shokohi, T., Rezai, M. S., Ilkit, M., Mahmoodi Nesheli, H., Karami, H., & Badali, H. (2020). Epidemiological features of nosocomial candidaemia in neonates, infants and children: A multicentre study in Iran. Mycoses, 63(4), 382-394. 10.1111/myc.13053
Alves, J., Alonso-Tarrés, C., & Rello, J. (2022). How to Identify Invasive Candidemia in ICU—A Narrative Review. 11(12), 1804.
Behera, C., Mishra, R., Jena, P., Mishra, S., Sahoo, B., Patnaik, S., & Jain, M. (2020). Candidemia in the pediatric intensive care unit in Eastern India. Journal Of Pediatric Critical Care, 7. 10.4103/JPCC.JPCC_38_20
Blyth, C. C., Chen, S. C., Slavin, M. A., Serena, C., Nguyen, Q., Marriott, D., & Sorrell, T. C. (2009). Not just little adults: candidemia epidemiology, molecular characterization, and antifungal susceptibility in neonatal and pediatric patients. Pediatrics, 123(5), 1360-1368. 10.1542/peds.2008-2055
Caggiano, G., Lovero, G., De Giglio, O., Barbuti, G., Montagna, O., Laforgia, N., & Montagna, M. T. (2017). Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data. Biomed Res Int, 2017, 7901763. 10.1155/2017/7901763
Carr, A., Colley, P., Berhe, M., & Nguyen, H. L. (2018). Evaluating predictors of invasive candidiasis in patients with and without candidemia on micafungin. Proc (Bayl Univ Med Cent), 31(1), 30-34. 10.1080/08998280.2017.1396164
Chakrabarti, A., Sood, P., Rudramurthy, S. M., Chen, S., Jillwin, J., Iyer, R., & Pamidimukkala, U. (2020). Characteristics, outcome and risk factors for mortality of paediatric patients with ICU-acquired candidemia in India: A multicentre prospective study. Mycoses. 10.1111/myc.13145
Dinç, F., Akalin, H., Özakin, C., Sinirtaş, M., Kebabçi, N., Işçimen, R., & Kahveci, F. (2016). Comparison of blood culture and multiplex real-time PCR for the diagnosis of nosocomial sepsis. Minerva Anestesiol, 82(3), 301-309.
Filioti, J., Spiroglou, K., & Roilides, E. (2007). Invasive candidiasis in pediatric intensive care patients: epidemiology, risk factors, management, and outcome. Intensive Care Med, 33(7), 1272-1283. 10.1007/s00134-007-0672-5
Gebremicael, M. N., Nuttall, J. J. C., Tootla, H. D., Khumalo, A., Tooke, L., Salie, S., & Eley, B. S. (2023). Candida bloodstream infection among children hospitalised in three public-sector hospitals in the Metro West region of Cape Town, South Africa. BMC Infectious Diseases, 23(1), 67. 10.1186/s12879-023-08027-z
Hope, W. W., Castagnola, E., Groll, A. H., Roilides, E., Akova, M., Arendrup, M. C., & Ullmann, A. J. (2012). ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microbiol Infect, 18 Suppl 7, 38-52. 10.1111/1469-0691.12040
Karadag-Oncel, E., Kara, A., Ozsurekci, Y., Arikan-Akdagli, S., Cengiz, A. B., Ceyhan, M., & Ozkaya-Parlakay, A. (2015). Candidaemia in a paediatric centre and importance of central venous catheter removal. Mycoses, 58(3), 140-148. 10.1111/myc.12288
Keighley, C., Cooley, L., Morris, A. J., Ritchie, D., Clark, J. E., Boan, P., & Worth, L. J. (2021). Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings, 2021. Intern Med J, 51 Suppl 7, 89-117. 10.1111/imj.15589
Lass-Flörl, C. (2010). Invasive fungal infections in pediatric patients: a review focusing on antifungal therapy. Expert Rev Anti Infect Ther, 8(2), 127-135. 10.1586/eri.09.128
Motta, F. A., Dalla-Costa, L. M., Muro, M. D., Cardoso, M. N., Picharski, G. L., Jaeger, G., & Burger, M. (2017). Risk factors for candidemia mortality in hospitalized children. J Pediatr (Rio J), 93(2), 165-171. 10.1016/j.jped.2016.05.007
Reda, N. M., Hassan, R. M., Salem, S. T., & Yousef, R. H. A. (2023). Prevalence and species distribution of Candida bloodstream infection in children and adults in two teaching university hospitals in Egypt: first report of Candida kefyr. Infection, 51(2), 389-395. 10.1007/s15010-022-01888-7
Rodriguez, D., Park, B. J., Almirante, B., Cuenca-Estrella, M., Planes, A. M., Mensa, J., & Pahissa, A. (2007). Impact of early central venous catheter removal on outcome in patients with candidaemia. Clin Microbiol Infect, 13(8), 788-793. 10.1111/j.1469-0691.2007.01758.x
Toassi, R. F. C., & Petry, P. C. (2021). Metodologia científica aplicada à área da Saúde.
Yılmaz-Ciftdoğan, D., Kara-Aksay, A., Erbaş, G., Sarkış Ü, B., Karadağ-Oncel, E., Anıl, A. B., & Yılmaz, N. (2021). Epidemiology of Candidemia in Children over 7 Years in a Medical Center in Turkey. Microbiol Spectr, 9(2), e0045321. 10.1128/Spectrum.00453-21
Zaoutis, T. (2010). Candidemia in children. Curr Med Res Opin, 26(7), 1761-1768. 10.1185/03007995.2010.487796
Zaoutis, T. E., Greves, H. M., Lautenbach, E., Bilker, W. B., & Coffin, S. E. (2004). Risk factors for disseminated candidiasis in children with candidemia. Pediatr Infect Dis J, 23(7), 635-641. 10.1097/01.inf.0000128781.77600.6f
Zaoutis, T. E., Prasad, P. A., Localio, A. R., Coffin, S. E., Bell, L. M., Walsh, T. J., & Gross, R. (2010). Risk factors and predictors for candidemia in pediatric intensive care unit patients: implications for prevention. Clin Infect Dis, 51(5), e38-45. 10.1086/655698
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Fernanda Toaldo; Mariana Millan Fachi; Marinei Campos Ricieri; Lucas Miyake Okumura; Fábio Araújo Motta
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
