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Boletín Médico del Hospital Infantil de México

2007, Number 2

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Bol Med Hosp Infant Mex 2007; 64 (2)

Risk factors associated with mortality due to Candida sp. infections in children.

Reséndiz-Sánchez J, Morales-Aguirre JJ

Language: Spanish
References: 25
Page: 81-98
PDF size: 154.02 Kb.


ABSTRACT

Introduction. A dramatic increase in the incidence of fungal infections has been reported in recent years. This is especially true with regards to infections due to Candida non albicans. The main risk factors associated with mortality include: age, invasive procedures and previous use of antibiotics.
Material and methods. A retrospective study of series of cases, in the Hospital Infantil de Mexico Federico Gomez, including children less than 18 years of age, with a diagnosis of systemic fungal infection and the isolation of C. albicans from sterile sites, during the period from May 1999 to December 2004. The objective was to analyze the factors associated to death. We reviewed the microbiology archives to identify the isolation of yeast from sterile sites including: blood, urine, CSF, and biopsy specimens. The information was obtained from the Hospital mycology laboratory. The individual patient record was carefully reviewed in efforts to determine possible risk factors at the time of the positive cultures as well as the antecedent 30 days.
Results. We observed an increase in the rates of infection per 1 000 discharges from 1999 to 2004. We observed 45 infectious events due to Candida sp., with a mortality of 35.5%. We did not identify the species in 18 patients, C. albicans in 16 events and other non albicans in 24%. In 12 patients the underlying diagnosis was cancer; gastrointestinal malformations in 6, congenital heart disease in 12 patients, malformations of digestive tube and sepsis in 6, congenital cardiopathy and renal failure in 3, hepatic diseases in 4 and others disease entities in 10 patients. In 88.8% the infections were of nosocomial origin. The age group with the highest mortality was newborns. The main factors associated with mortality were: the antecedent of thrombocytopenia and neutropenia, as well as being intubated at the moment of the infection.
Conclusions. Fungal infections and particularly those due to Candida sp., represent an important cause of morbidity and mortality. The associated risk factors are those due to an immunocompromised state, protracted use of broad spectrum antibiotics and invasive procedures including endotracheal intubation. An increase in the isolation of non- albicans/i> species was noted.


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