Candidiasis in Pediatric Hematopoietic Cell Transplantation

First Author(s)

• ND

  Noah Defauwes, n/a

  Pre Medical Student
  University of Florida
  Miami, Florida, United States

  Disclosure information not submitted.

Research Presenters(s)

• 

  Prithvi Raj Sendi, MD

  Nicklaus Children's Hospital
  Miami, Florida

  Disclosure information not submitted.

  Slides

Co-Author(s)

• PM

  Paul Martinez, MD

  Assistant Professor
  Nicklaus Children's Hospital, United States

  Disclosure information not submitted.
• BT

  Balagangadhar Totapally, MBBS, MD, DCH, MRCP, FAAP, FCCP, FCCM

  Chief, Division of Critical Care Medicine. Program Director, Critical Care Fellowship Program
  Nicklaus Children's Hospital, United States

  Disclosure information not submitted.

Title: Candidiasis in Pediatric Hematopoietic Stem Cell Transplantation

Introduction: Candidiasis is a serious cause of invasive infection in hematopoietic stem cell transplant (HSCT) recipients. The aim of this study is to evaluate the epidemiology, prevalence, trend analysis and mortality in children with candidal infection who received HSCT in the years 1997-2016.

Methods: A retrospective analysis using Healthcare Cost and Utilization Project’s Kids’ Inpatient Database form the years 1997 to 2016 was performed. HSCT recipients with candidal infection were narrowed using respective ICD 9 and ICD 10 codes. Univariate and multivariable regression analysis was used to assess various factors influencing mortality in HSCT recipients with candidal infection. Results were presented as Odds ratio with 95% CI. Trend analysis was performed to evaluate prevalence and mortality of candidal infection in HSCT recipients. Continuous variables were presented as median with interquartile range.

Results: Among a total of 16,840 HSCT recipients from 1997 to 2016, 1192 patients had candidal infection (7.1%). Among HSCT recipients with candidal infection, majority were males (57.4%) and were in the age group of 12-18 years (24.8%). Candidal infection was more prevalent in recipients of cord blood transplant (8.2%) compared to allogeneic (7.8%) and autologous transplant (5.9%). Overall mortality for HSCT recipients with candidal infection was 11.3%. On multivariable analysis, mortality was higher when associated in invasive mechanical ventilation (IMV) (OR:34.9, 95%CI:28.7-42.5), cardiac arrest (OR:26.2, 95%CI:13.1-52.5), hemodialysis (HD) (OR:15.0, 95%CI:10.3-21.6), cord blood transplant (OR:4.6, 95%CI:3.4-6.1), early adolescents (12-18 years) (OR:2.1, 95%CI:1.5-3.0) and acute graft versus host disease (GVHD) (OR:1.5, 95%CI:1.1-2.2). Trend analysis demonstrated no change in prevalence or case fatality rate from candida infection among HSCT recipients from 1997 to 2016 (p=0.5 and p=0.4). The median age was 7 years (IQR: 2-14) and length of stay was 42 days (IQR 29-72).

Conclusions: Our study reflects the prevalence and mortality associated with candidal infection in HSCT recipients from 1997-2016 is unchanged. candidal infection is more common in early adolescents and cord-blood transplant recipients. Mortality is higher when associated with IMV, cardiac arrest, HD, cord blood transplant and acute GVHD.