CANDIDEMIA IN A PEDIATRIC POPULATION

Candidemia results in a mortality of >50% among adults, but data on ch ildren with candidemia are limited. We reviewed 70 episodes of pediatr ic candidemia that occurred between January 1988 and October 1992. Of these episodes, 53% were caused by Candida albicans, 24% were caused b y Candida parapsilosis, 16% were caused by Candida tropicalis, and 3% were caused by Candida krusei. Twenty-five percent of the patients wer e premature infants. Other underlying conditions included malignancy ( 15%); cardiac disease (14%); and short-gut syndrome (14%). A central v enous catheter was in place during 61 (87%) of 70 episodes. Candiduria preceded candidemia in only 4 (8%) of 52 patients. The overall mortal ity rate was 19%; 36% of those with intravenous catheters that were no t removed within 3 days died, whereas none of the patients from whom c atheters were removed within 3 days died (P < .0001). Only two survivo rs had complications. Therapy with amphotericin B (with or without flu cytosine) was administered to 74% of these patients. Seventeen patient s were not treated medically; all were immunocompetent and survived. O f these patients, 15 were >2 months of age; 14 had candidemia for less than or equal to 2 days; and 15 had an intravenous catheter removed w ithin 2 days of the onset of candidemia. No patient stopped receiving amphotericin B because of side effects. The results of this study sugg est the following: that mortality associated with candidemia is lower among children than among adults; that failure to remove the indwellin g intravenous catheter usually results in a poor outcome; that candidu ria rarely precedes candidemia in children; and that amphotericin B is well tolerated by children.