RISK-FACTORS FOR CANDIDEMIA IN A CHILDRENS-HOSPITAL

Candida species are increasingly important nosocomial pathogens in cri tically ill children. A 2.3-fold increase in the rate of nosocomial ca ndidemia at our 200-bed tertiary care children's hospital prompted a s tudy to identify risk factors for this infection. Twenty-six cases wer e identified between 1992 and 1993, representing 21% of all nosocomial bloodstream infections. Candida albicans was the most frequent isolat e (58%), followed by Candida parapsilosis (27%). A case-control study revealed that there was a statistically significant association betwee n the occurrence of candidemia and placement of a central venous cathe ter in the femoral vein (P = .03), the use of a tunneled central venou s catheter (P = .05), and prolonged hyperalimentation (P = .04). Patie nts with candidemia also were noted to have candiduria more often than controls (P = .003) and were more likely to have had topical antifung al agents prescribed (P = .04). Multivariate analysis showed that hype ralimentation was an independent risk factor for the development of ca ndidemia. We conclude that measures must be taken to reduce these risk factors whenever possible.