Male sex, delayed sternal closure tied to postoperative candidemia in children with CHD

Though uncommon, candidemia following cardiac surgery in children with congenital heart defect (CHD) proves to be a serious complication, reveals a study. The most common cause of non-albicans candidemia is the high frequency of fluconazole-resistant C. parapsilosis.

“In addition to confirming previously recognized risk factors, our results reveal new potential risk factors such as delayed sternal closure and male sex,” the investigators said.

This retrospective case‒control study conducted in two paediatric intensive care units between 2004 and 2019 included all patients <18 years of age who developed candidemia after cardiac surgery. Each patient was matched with two controls based on age and date of surgery. The investigators determined the risk factors for postoperative candidemia using multivariable logistic regression analysis.

Thirty-five children with candidemia had been identified and matched to 70 control patients. The incidence of candidemia was 6.3 episodes for every 1,000 admissions, while the median age of those with such complication was 4 months. Mortality attributable to candidemia stood at 28.5 percent.

Non-albicans Candida species is the predominant pathogen (54 percent), with C. parapsilosis isolates shown to be highly resistant to fluconazole (70 percent).

The following risk factors were independently associated with candidemia: cumulative antibiotic exposure for ≥4 days (odds ratio [OR], ‒4.3, 95 percent confidence interval [CI], 1.3‒14.6; p=0.02), need for total parenteral nutrition or peritoneal dialysis (OR, ‒6.1, 95 percent CI, 2 to ‒18.8; p=0.001), male sex (OR, 6.2, 95 percent CI, 1.9‒20.3; p=0.002), and delayed sternal closure ≥2 days (OR, ‒3.2, 95 percent CI, 1‒11.2; p=0.05).

“Candidemia is a serious complication in paediatric patients with CHD after cardiac surgery,” the investigators said.