Risk Adjustment for Congenital Heart Surgery Score as a Risk Factor for Candidemia in Children Undergoing Congenital Heart Defect Surgery
| Autor: | Libera Maria Dalla-Costa, Marion Burger, Marisol Dominguez Muro, Andrea Lenzi, Fabio de Araujo Motta, Gledson Luiz Picharski |
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| Rok vydání: | 2016 |
| Předmět: |
Heart Defects
Congenital Male 0301 basic medicine Microbiology (medical) medicine.medical_specialty Pediatrics 030106 microbiology law.invention 03 medical and health sciences 0302 clinical medicine Risk Factors law Case fatality rate medicine Humans 030212 general & internal medicine Cardiac Surgical Procedures Risk factor Pediatric intensive care unit business.industry Incidence (epidemiology) Candidemia Infant Odds ratio Intensive care unit Confidence interval Surgery Cardiac surgery Infectious Diseases Case-Control Studies Pediatrics Perinatology and Child Health Female business |
| Zdroj: | Pediatric Infectious Disease Journal. 35:1194-1198 |
| ISSN: | 0891-3668 |
| Popis: | BACKGROUND Candida species are the primary cause of invasive fungal infection in hospitalized children. There are few data on risk factors for postoperative candidemia in pediatric patients with congenital heart defects. This study aimed to identify risk factors for candidemia in patients with congenital heart defects who underwent cardiac surgery. METHODS This was a case-control study conducted in patients admitted to a pediatric cardiology intensive care unit from January 2006 to December 2013. Candidemia cases were matched with control patients without candidemia. Multivariate analyses were conducted to determine predictive probabilities for the incidence of candidemia at a risk higher than 10%. RESULTS Thirty patients diagnosed with candidemia (incidence: 0.7 cases/1000 patient days) were matched with 75 controls. Risk factors independently associated with candidemia included Risk Adjustment for Congenital Heart Surgery (RACHS-1) category ≥3 [odds ratio (OR) = 3.165, 95% confidence interval: 1.377-8.467], use of acid suppression therapy (OR = 1.9, 95% confidence interval: 0.949-3.979) and thrombocytopenia (OR = 2.2, 95% confidence interval: 1.2-4.2). Predictive probabilities ranged from 11% (only in RACHS-1 category ≥3) to 58% (combined RACHS-1 ≥3, thrombocytopenia and acid suppression therapy use). The case fatality rate within 30 days after candidemia was 50%. CONCLUSION This is the first report using the RACHS-1 category as a risk factor for invasive candidiasis in patients with congenital heart defects in the pediatric intensive care unit. Further studies must be conducted to validate the risk factors for candidemia in this pediatric population. |
| Databáze: | OpenAIRE |
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