Comparative analysis of candidemia patients in pediatric and adult intensive care units regarding epidemiological, clinical features, and mortality risk factors

This study aimed to determine the clinical characteristics and mortality risk factors of candidemia in pediatric and adult patients in intensive care units. The study included patients over 18 years old and 1 month to 18 years old with candidemia in ICUs of Ankara Bilkent City Hospital, between June 2019 and December 2022. 101 (57%) pediatric, 75 (42.6%) adult patients with candidemia were included the study over a 3.5-year period. Underlying diseases, hypotension, steroid use, urinary catheterization, and intubation were more common in adults, whereas recent hospitalizations, fever, surgical history, and total hospital stay were higher in children. The most frequently isolated Candida species in both patient groups was C. albicans, and non-albicans Candida species were detected more frequently than C. albicans species. C. glabrata was more common in adults than in children (3% vs. 14.7%). Fluconazole was commonly used in children, while echinocandins were preferred in adults. Seven and 30-day mortality rates were higher in adults than in children (7-day 49.3% vs. 8.9%; 30-day 68% vs. 15.8%; both p<0.001). Steroid use (OR: 6.6, p=0.001), urethral catheterization (OR: 1.2, p=0.011), intubation (OR: 6.5, p=0.006), non-removal of catheters post-candidemia (OR: 11.2, p=0.001), and thrombocytopenia (OR: 1.5, p=0.001) were significant risk factors for 30 day mortality in children. Multivariate logistic regression analysis identified steroid use (OR: 9.2), non-removal of catheters (OR: 24.5), and thrombocytopenia (OR: 8.8) as significant factors. In adults, non-removal of catheters (OR: 4.1, p=0.024), thrombocytopenia (OR: 1.6, p=0.001), leukocytosis (OR: 1.16, p=0.040), and lack of antifungal treatment (OR: 1.7, p=0.001) were significant mortality risk factors. Logistic regression found that non-removal of catheters (OR: 4.3) and leukocytosis (OR: 2.5) were significant. These findings underscore the importance of developing tailored management strategies to reduce candidemia-related mortality in pediatric and adult ICUs.