Main Article Content
Fungal infection, neutropenia, leukemia
Background and Objectives: Candida-associated bloodstream infections are frequent and potentially life-threatening conditions in hematology patients. The aim of this study is to evaluate the characteristics, risk factors, and outcome of Candida-associated bloodstream infections in children with hematological diseases at a children’s hospital.
Methods: The medical records of the patients with hematological diseases and hematopoietic stem cell transplantation (HSCT) recipients who were diagnosed as Candida-associated bloodstream infection between February 2010 and February 2014 were reviewed retrospectively.
Results: Thirty episodes of candidemia involving 26 patients (38% female, and 62% male) with median age of 7 years (range; 1 to 17) were noted. Infections with non-albicans Candida spp. occurred more frequently (63%) and C. krusei was the predominant microorganism among non-albicans Candida spp. (37%). Candida albicans was isolated from 11 of the 30 episodes (37%). Twenty-three of the patients (88%) had central venous catheter (CVC) prior to candidemia, and they were removed in 16 of the 30 episodes (53%). Isolated Candida spp, underlying disease and status of the disease, presence of mucositis, neutropenia, using of broad spectrum antibiotics, corticosteroids or total parenteral nutrition were not identified as predictors of outcome. However patients whose CVCs had not been removed were more likely to die than those whose had been removed (54% vs. 6%, respectively; p=0.012).
Conclusions: Candida-associated bloodstream infections in children with hematological diseases and HSCT recipients were common particularly in patients with CVCs. Beside appropriate antifungal therapy, CVC removal improves the outcome of candidemia in children with hematological disease.
 Tragiannidis A, Fegeler W, Rellensmann G, Debus V, Müller V, Hoernig-Franz I, Siam K, Pana ZD, Jürgens H, Groll AH. Candidaemia in a European Paediatric University Hospital: a 10-year observational study. Clin Microbiol Infect. 2012; 18: 27-30.
 Zaoutis TE, Greves HM, Lautenbach E, Bilker WB, Coffin SE. Risk factors for disseminated candidiasis in children with candidemia. Pediatr Infect Dis J. 2004; 23: 635-41.
 Simon A, Bode U, Beutel K. Diagnosis and treatment of catheter-related infections in paediatric oncology: an update. Clin Microbiol Infect. 2006; 12: 606-20.
 Kojic EM, Darouiche RO. Candida infections of medical devices. Clin Microbiol Rev. 2004; 17: 255-67.
 Acar A, Oncül O, Küçükardali Y, Ozyurt M, Haznedaro?lu T, Cavu?lu S. Epidemiological features of Candida infections detected in intensive care units and risk factors affecting mortality. Mikrobiyol Bul. 2008 ;42 :451-61.
 Celebi S, Sezgin ME, Cak?r D, Baytan B, Demirkaya M, Sevinir B, Bozdemir SE, Gunes AM, Hacimustafaoglu M. Catheter-associated bloodstream infections in pediatric hematology-oncology patients. Pediatr Hematol Oncol. 2013; 30: 187-94.
 Infectious Diseases Society of America. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009; 48: 503-35.
 ESCMID Fungal Infection Study Group. 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. 2012; 18(Suppl 7): 38-52.
 Tragiannidis A, Tsoulas C, Groll AH. Invasive candidiasis and candidaemia in neonates and children: update on current guidelines. Mycoses. 2015; 58: 10-21.
 Viscoli C, Girmenia C, Marinus A, Collette L, Martino P, Vandercam B, Doyen C, Lebeau B, Spence D, Krcmery V, De Pauw B,Meunier F. Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis. 1999; 28: 1071-9.
 Rosen GP, Nielsen K, Glenn S, Abelson J, Deville J, Moore TB. Invasive fungal infections in pediatric oncology patients: 11-year experience at a single institution. J Pediatr Hematol Oncol. 2005; 27: 135-140.
 Castagnola E, Cesaro S, Giacchino M, Livadiotti S, Tucci F, Zanazzo G, Caselli D, Caviglia I, Parodi S, Rondelli R, Cornelli PE,Mura R, Santoro N, Russo G, De Santis R, Buffardi S, Viscoli C, Haupt R, Rossi MR. Fungal infections in children with cancer: a prospective, multicenter surveillance study. Pediatr Infect Dis J. 2006; 25 :634-9.
 Velasco E, Bigni R. A prospective cohort study evaluating the prognostic impact of clinical characteristics and comorbid conditions of hospitalized adult and pediatric cancer patients with candidemia. Eur J Clin Microbiol Infect Dis. 2008; 27: 1071-8.
 Mor M, Gilad G, Kornreich L, Fisher S, Yaniv I, Levy I. Invasive fungal infections in pediatric oncology. Pediatr Blood Cancer. 2011; 56: 1092-7.
 Kobayashi R, Kaneda M, Sato T, Ichikawa. M, Suzuki D, Ariga T. The clinical feature of invasive fungal infection in pediatric patients with hematologic and malignant diseases: a 10-year analysis at a single institution at Japan. J Pediatr Hematol Oncol. 2008; 30: 886-90.
 Kremery V, Barnes AJ. Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance. J Hosp Infect. 2002; 50: 243-60.
 Nucci M, Anaissie E. Should vascular catheters be removed from all patients with candidemia? An evidence-based review. Clin Infect Dis. 2002; 34: 591-9.
 Miller PJ, Wenzel RP. Etiologic organisms as independent predictors of death and morbidity associated with bloodstream infections. J Infect Dis. 1987; 156: 471-7.