Candida infection in pediatric liver transplant recipients

A retrospective review of 100 liver transplantations in 98 children was per formed to determine the incidence of infection caused by Candida organism i n these patients and to identify risk factors that may predispose to seriou s fungal infection. Thirty-one infections caused by Candida organisms devel oped during the initial 28 days posttransplantation: 19 were definite invas ive infections (one deep site or one positive blood culture), 2 were probab le invasive infections (three superficial sites), and 10 were urinary tract infections, Eleven of 19 patients had fungemia or a disseminated infection (two noncontiguous deep organs involved and/or positive blood cultures) an d 8 of 19 had peritoneal candidiasis, Infection caused by Candida organisms was a contributing factor to mortality in 7 of 21 patients (case fatality rate of 33%) with invasive infection. Risk factors that were predictive for invasive infection by univariate analysis included the following: pretrans plantation antibiotic therapy, length of transplant operation, transfusion requirement, number of days in the intensive care unit, number of days intu bated, number of concurrent bacterial infections, number of antibiotics adm inistered, number of laparotomies performed posttransplantation, retranspla ntation, hepatic artery thrombosis, bile leaks, and renal and respiratory f ailure, By logistic regression analysis, bile leak, hepatic artery thrombos is, preoperative steroid use, transfusion requirement, and the number of da ys intubated were identified as independent risk factors for invasive infec tion caused by Candida organisms, The use of prophylactic antifungal agents in high-risk patients may be important in reducing the serious morbidity a nd mortality associated with sepsis caused by Candida organisms in pediatri c liver transplant recipients, Copyright (C) 1999 by the American Associati on for the Study of Liver Diseases.