Factors Associated with the Presentation of Candidemia in Pediatric Population in Hospitalization Services, Pediatric Intensive Care Units, and Neonatal Units from 2018 to 2023 at Fundación Cardiovascular de Colombia (FCV) and Hospital Internacional
Laura I Manosalva, José A Vargas, Jesy C BuitragoAbstract
Introduction
Since 2022, the WHO has considered infections caused by Candida spp. as priority fungal pathogens. In the context of high resistance, limited antifungal agents, and few diagnostic methods, present challenges in detecting infections from reemerging subspecies such as C. auris. These infections significantly affect patients with severe pathologies requiring inpatient care due to advances in medicine.
Methodology
This is a retrospective case-control study aimed at determining the demographic and clinical factors associated with the presentation of candidemia in a pediatric population from 0 to 18 years old who were admitted to hospitalization services, pediatric intensive care units, and neonatal units in two high-complexity institutions in Bucaramanga between 2018 and 2023. An 80% power and statistical significance of p<0.05 were considered for sample size calculation. A univariate and bivariate analysis was performed using chi-square tests and Mann-Whitney U tests to establish associations and logistic regression to identify the factors that best explain the presentation of candidemia.
Results
A total of 67 cases of candidemia were detected, establishing a 1:1 case-control ratio, with cases found in the same pediatric department. Regarding demographic characteristics, the median age was 4 months (IQR 1-20), with a predominance of male sex in the cases (55.2% vs. 44.8%), and the Caribbean region contributed the most cases of candidemia (23.9%) compared to controls. Significant differences were found between the groups regarding days of hospitalization before admission (p = 0.043) and total length of stay (p = 0.024). Respiratory diseases (32.8%) and cardiovascular diseases (32.8%) affected most cases, followed by oncological and gastrointestinal pathologies. Infections caused by C. non-albicans were the most frequent (83.6%) compared to 16.4% caused by C. albicans. Among subspecies, C. parapsilosis (46.2%) was the leading cause of candidemia, followed by C. auris (17.9%) and C. albicans (11.6%). The main factors associated were TPN (ORa 6.82, 95% CI 2.31 – 20.1), mechanical ventilation (ORa 2.91, 95% CI 1.08 – 7.79), and respiratory pathology (ORa 3.76, 95% CI 1.12 – 12.6).
Conclusion
Candidemia has been shown to change over time about pathogens and their causal subspecies in this deadly infection in the pediatric population. C. auris has emerged as the second leading cause, gaining ground in its presentation in the hospital setting. Therefore, it is important to address the factors associated with this type of infection.