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Background: Candida species are the leading cause of invasive fungal infections in hospitalized children and are the third most common cause of pediatric healthcare-associated bloodstream infection in the United States. Little is known about the recent trends in the prevalence of candidemia within this population. We hypothesized that expanded prophylactic use of antifungal agents may have reduced the burden of candidemia among hospitalized children.
Objective: To describe the trends in candidemia from 2003 to 2009 among hospitalized children.
Methods: The Pediatric Health Information System (PHIS), an administrative database containing information from 43 free standing United States children's hospitals, was used to describe the prevalence of candidemia (ICD-9 code 112.5 disseminated/systemic candidiasis) among pediatric inpatients from January 1, 2003 to December 31, 2009. Previous data suggest that this code has high specificity for identifying candidemia. The rate of both antibiotic and fluconazole use were also collected. Chronic medical conditions were identified using a previously validated system of grouping ICD-9 discharge diagnosis codes.
Results: During the 7-year study period, 3955 discharges included a code for candidiemia. In 2003, the rate of candidemia was 14.7/10,000 patient discharges whereas in 2009 the rate of candidemia was 6.7/10,000 patient discharges (p<0.0001). The most common chronic medical conditions in patients with candidemia included cardiovascular (24%), malignancy (20%), and respiratory diagnoses (17%). Most patients (74%) received total parenteral nutrition, 50% received mechanical ventilation, and 36% received care in the intensive care unit during their hospitalization. Rates of both candidemia and antibiotic use decreased significantly during the study period (p =0. 03, p = 0.05, respectively), while there was no change in fluconazole use (see figure).
*statistically significant
Conclusions: Rates of candidemia in hospitalized children have decreased significantly over the past 7 years, while the utilization of fluconazole, the drug most commonly used for antifungal prophylaxis, remained stable. One possible explanation for this decrease in candidemia would be a simultaneous increase in efforts to reduce catheter related bloodstream infections.