Determination of risk factors in patients with candidemia in Pediatric Clinics of Bursa Uludağ University Medical Faculty: Five-year retrospective study

Candidemia is the most common type of infection in patients with invasive candidiasis. The aim of this study was to evaluate the clinical and laboratory findings of patients with candidemia in a pediatric clinic of a tertiary hospital retrospectively. In 37 cases followed up at Uludağ University Faculty of Medicine Pediatric Clinics between January 2013-December 2017.candidemia attacks were detected. Sixty two percent of the cases were male and the median age was 39.9 months (15 days–192 months). The most frequent underlying diseases were malignancies (30%), especially hematologic, followed by prematurity (24%). 67% (n=25) of the patients were followed up in the intensive care unit and 54% (n=20) were intubated. Eighty one percent of the patients (n=30) had central venous catheter, 76% (n=28) had total parenteral nutrition, and 42% (n=16) had previous operation. Thirty eight percent (n=14) of the patients were receiving immunosuppressant therapy and 22% (n=8) were neutropenic. Seventy three percent (n=27) of the episodes had concomitant bacteremia and 80% (n=30) of the patients were receiving simultaneous broad-spectrum antibiotics during the candidaemia attack. In 73% of the cases, non-albicans candidia was isolated, and C. parapsilosis (45,9%) was the most common pathogen. White blood cell, neutrophil and platelet counts were found to be lower in non- albicans candida than in C. albicans (p=0.009, p=0.004, p=0.022, respectively). The mortality rate was 27% of all children with candidemia in the present study, there was no statistical difference between albicans and non-albicans candida in terms of mortality (p=0.694). Predisposing factors associated with candidemia-related deaths were presence of thrombocytopenia and mechanical ventilation (p=0.01, p=0.01, respectively). Conclusion, in this study, it was found that most of the patients with candidaemia were intubated in the intensive care unit, and the majority of them received broad-spectrum antibiotics, had central venous catheter and received total parenteral nutrition. The mortality rate was 27% of all children with candidemia in this study. Predisposing factors associated with candidemia-related deaths were presence of thrombocytopenia and mechanical ventilation.