Risk factors for systemic Candida infections in pediatric small bowel transplant recipients

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Abstract

Background: Fungal infections are an important cause of morbidity and mortality after small bowel transplantation (SBT). Little information about risk factors for Candida infections in pediatric SBT is available. Methods: We performed a 1:1 matched retrospective case-control study including 23 Candida culture-positive patients (cases) and 23 culturenegative patients (controls), matched based on age and time of transplantation. Patients' characteristics were compared using Wilcoxon rank-sum, χ 2, or Fisher exact tests. McNemar test was used to assess discordance between pretransplant and posttransplant fungemia. Univariate and multivariable conditional logistic regression analyses were performed to identify risk factors. Results: The median age of the group was 1.87 years (range, 0.87-17.60); 59% patients were male. Within 1 month before transplant, 8.7% cases had fungemia and within 1-6 months before transplant, 30.4% cases had fungemia, compared with 69.6% within the 12 months after transplantation (P = 0.0001 and P = 0.02). By univariate analysis, total parenteral nutrition (TPN) (odds ratio [OR[, 17.0 [95% confidence interval: 2.12, 2198]; P = 0.003) and antibiotic administration (OR, 18.99 [2.42, 2449]; P = 0.002) were risk factors for fungal infections. By multivariable analysis, both remained independent risk factors (TPN: OR, 10.86 [1.23, 1425], P = 0.03; antibiotic administration: OR, 12.83 [1.52, 1672], P = 0.01). Conclusions: Fungemia was significantly more frequent after SBT than before transplantation. Patients receiving TPN and antibiotic treatment had, respectively, 11 and 13 times higher risk of developing Candida infections after SBT.

Original languageEnglish (US)
Pages (from-to)120-123
Number of pages4
JournalPediatric Infectious Disease Journal
Volume31
Issue number2
DOIs
StatePublished - Feb 1 2012

Fingerprint

Fungemia
Transplantation
Pediatrics
Total Parenteral Nutrition
Candida
Mycoses
Anti-Bacterial Agents
Transplants
Infection
Systemic candidiasis
Transplant Recipients
Case-Control Studies
Age Groups
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals
Morbidity
Mortality

Keywords

  • Candida
  • Pediatric
  • Risk factors
  • Small bowel
  • Transplant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{1956f573ef5a47bb86e37f6213d2bcb2,
title = "Risk factors for systemic Candida infections in pediatric small bowel transplant recipients",
abstract = "Background: Fungal infections are an important cause of morbidity and mortality after small bowel transplantation (SBT). Little information about risk factors for Candida infections in pediatric SBT is available. Methods: We performed a 1:1 matched retrospective case-control study including 23 Candida culture-positive patients (cases) and 23 culturenegative patients (controls), matched based on age and time of transplantation. Patients' characteristics were compared using Wilcoxon rank-sum, χ 2, or Fisher exact tests. McNemar test was used to assess discordance between pretransplant and posttransplant fungemia. Univariate and multivariable conditional logistic regression analyses were performed to identify risk factors. Results: The median age of the group was 1.87 years (range, 0.87-17.60); 59{\%} patients were male. Within 1 month before transplant, 8.7{\%} cases had fungemia and within 1-6 months before transplant, 30.4{\%} cases had fungemia, compared with 69.6{\%} within the 12 months after transplantation (P = 0.0001 and P = 0.02). By univariate analysis, total parenteral nutrition (TPN) (odds ratio [OR[, 17.0 [95{\%} confidence interval: 2.12, 2198]; P = 0.003) and antibiotic administration (OR, 18.99 [2.42, 2449]; P = 0.002) were risk factors for fungal infections. By multivariable analysis, both remained independent risk factors (TPN: OR, 10.86 [1.23, 1425], P = 0.03; antibiotic administration: OR, 12.83 [1.52, 1672], P = 0.01). Conclusions: Fungemia was significantly more frequent after SBT than before transplantation. Patients receiving TPN and antibiotic treatment had, respectively, 11 and 13 times higher risk of developing Candida infections after SBT.",
keywords = "Candida, Pediatric, Risk factors, Small bowel, Transplant",
author = "Florescu, {Diana F} and Fang Qiu and Mercer, {David F} and Langnas, {Alan Norman} and Shafer, {Laura R.} and Kalil, {Andre C}",
year = "2012",
month = "2",
day = "1",
doi = "10.1097/INF.0b013e31823a66d5",
language = "English (US)",
volume = "31",
pages = "120--123",
journal = "Pediatric Infectious Disease Journal",
issn = "0891-3668",
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T1 - Risk factors for systemic Candida infections in pediatric small bowel transplant recipients

AU - Florescu, Diana F

AU - Qiu, Fang

AU - Mercer, David F

AU - Langnas, Alan Norman

AU - Shafer, Laura R.

AU - Kalil, Andre C

PY - 2012/2/1

Y1 - 2012/2/1

N2 - Background: Fungal infections are an important cause of morbidity and mortality after small bowel transplantation (SBT). Little information about risk factors for Candida infections in pediatric SBT is available. Methods: We performed a 1:1 matched retrospective case-control study including 23 Candida culture-positive patients (cases) and 23 culturenegative patients (controls), matched based on age and time of transplantation. Patients' characteristics were compared using Wilcoxon rank-sum, χ 2, or Fisher exact tests. McNemar test was used to assess discordance between pretransplant and posttransplant fungemia. Univariate and multivariable conditional logistic regression analyses were performed to identify risk factors. Results: The median age of the group was 1.87 years (range, 0.87-17.60); 59% patients were male. Within 1 month before transplant, 8.7% cases had fungemia and within 1-6 months before transplant, 30.4% cases had fungemia, compared with 69.6% within the 12 months after transplantation (P = 0.0001 and P = 0.02). By univariate analysis, total parenteral nutrition (TPN) (odds ratio [OR[, 17.0 [95% confidence interval: 2.12, 2198]; P = 0.003) and antibiotic administration (OR, 18.99 [2.42, 2449]; P = 0.002) were risk factors for fungal infections. By multivariable analysis, both remained independent risk factors (TPN: OR, 10.86 [1.23, 1425], P = 0.03; antibiotic administration: OR, 12.83 [1.52, 1672], P = 0.01). Conclusions: Fungemia was significantly more frequent after SBT than before transplantation. Patients receiving TPN and antibiotic treatment had, respectively, 11 and 13 times higher risk of developing Candida infections after SBT.

AB - Background: Fungal infections are an important cause of morbidity and mortality after small bowel transplantation (SBT). Little information about risk factors for Candida infections in pediatric SBT is available. Methods: We performed a 1:1 matched retrospective case-control study including 23 Candida culture-positive patients (cases) and 23 culturenegative patients (controls), matched based on age and time of transplantation. Patients' characteristics were compared using Wilcoxon rank-sum, χ 2, or Fisher exact tests. McNemar test was used to assess discordance between pretransplant and posttransplant fungemia. Univariate and multivariable conditional logistic regression analyses were performed to identify risk factors. Results: The median age of the group was 1.87 years (range, 0.87-17.60); 59% patients were male. Within 1 month before transplant, 8.7% cases had fungemia and within 1-6 months before transplant, 30.4% cases had fungemia, compared with 69.6% within the 12 months after transplantation (P = 0.0001 and P = 0.02). By univariate analysis, total parenteral nutrition (TPN) (odds ratio [OR[, 17.0 [95% confidence interval: 2.12, 2198]; P = 0.003) and antibiotic administration (OR, 18.99 [2.42, 2449]; P = 0.002) were risk factors for fungal infections. By multivariable analysis, both remained independent risk factors (TPN: OR, 10.86 [1.23, 1425], P = 0.03; antibiotic administration: OR, 12.83 [1.52, 1672], P = 0.01). Conclusions: Fungemia was significantly more frequent after SBT than before transplantation. Patients receiving TPN and antibiotic treatment had, respectively, 11 and 13 times higher risk of developing Candida infections after SBT.

KW - Candida

KW - Pediatric

KW - Risk factors

KW - Small bowel

KW - Transplant

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