TY - JOUR
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 N.
AU - Shafer, Laura R.
AU - Kalil, Andre C.
PY - 2012/2
Y1 - 2012/2
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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U2 - 10.1097/INF.0b013e31823a66d5
DO - 10.1097/INF.0b013e31823a66d5
M3 - Article
C2 - 22094627
AN - SCOPUS:84858152138
VL - 31
SP - 120
EP - 123
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
SN - 0891-3668
IS - 2
ER -