Candidemia in children after complex congenital heart defects surgery treated with caspofungin – our own experience and a review of literature

Abstract

SummaryBackgroundInvasive fungal infections due to Candida species constitute an increasing clinical problem. There are no guidelines for the management of candidemia in children undergoing surgical procedures for congenital heart defects (CHD). The aim of the study was to draw attention to the problem of candidemia in children who are operated on due to congenital heart defects.Material/MethodsWe retrospectively analyzed medical documentation of 307 children with congenital heart defects treated in 1 clinical centre in Poland, from whom we selected those diagnosed with candidemia during the postoperative period. Next, we analyzed in detail the clinical course of invasive candidiasis in each individual and we performed an analysis of risk factors that lead to candidemia.ResultsIn the analyzed period, among 307 children who underwent surgical procedures, we observed 2 cases of candidemia (0.65%) which were effectively cured with caspofungin. No adverse effects were observed after treatment with the drug.ConclusionsCandidemia in children who undergo surgical treatment of congenital heart defects is an important factor that can influence final clinical results. Caspofungin may be an effective therapeutic option when treating candidemia in children after extensive cardiosurgical procedures.

A 5-year analysis of Candida bloodstream infections in the paediatric cardiovascular surgery ICU of a tertiary care centre

“…Surgical procedures, especially cardiovascular surgery, performed to correct complex congenital heart anomalies have been accepted as an important risk factor for Invasive Candida infections, most commonly Candida bloodstream infections. 11,12 Relevantly, the patients with Candida bloodstream infections in our study had undergone surgery for the correction of cardiac pathologies as atrioventricular septal defect (18.9%), transposition of great arteries (17.6%), tetralogy of Fallot (12.4%), total anomalous pulmonary venous return (4.3%), hypoplastic left heart syndrome (3.7%), double outlet right ventricle (2.2%), pulmonary atresia (1.5%), tricuspid atresia (1.5%) and the remaining for combined cardiac pathologies (transposition of great arteries þ double outlet right ventricle, total anomalous pulmonary venous return þ atrioventricular septal defect, transposition of great arteries þ aortic hypoplasia, ventricular septal defect þ pulmonary atresia) (37.9%). The RACHS-1, risk adjustment for congenital heart surgery, scores of these surgeries were between 2 and 5 out of 6.…”

Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) colonization as a risk factor for developing ESBL infections in pediatric cardiac surgery patients: “retrospective cohort study”

“…In cardiac surgery, factors such as extracorporeal circulation, hypothermia, peripheral tissue hypo-perfusion and invasive medical devices like implantable materials may constitute major risks for increased perioperative infection and complication rates [7]. …”

Frequency of Catheter Related Blood Stream Infections in a Cardiac Surgery Intensive Care Unit

“…19 Many invasive fungal infections due to Candida species are diagnosed after patient's death due to rapidly progressive clinical course and problems with prompt and early diagnosis. 20 Recent IDSA guidelines recommend use of empiric antifungal therapy in critically ill patients with risk factors for invasive candidiasis and no other known cause of fever. 21…”