{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T02:18:10Z","timestamp":1782958690644,"version":"3.54.5"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Candida infections have become a significant cause of morbidity and mortality in pediatric cardiac intensive care units following congenital heart surgery, ranking among the most common causes of complications in this patient population. There is a paucity of information available regarding the epidemiology, clinical features, and risk factors associated with candidemia in this patient population. The present study evaluates the incidence of Candida bloodstream infections in pediatric cardiac intensive care units. Methods: The study was conducted retrospectively on cases of patients under the age of 18 who were admitted to the pediatric cardiac intensive care unit between 1 January 2021 and 1 January 2024. The isolated pathogens were recorded. A reanalysis was conducted on 36 patients with Candida bloodstream infections, with data pertaining to age, weight, cardiac pathologies, duration of mechanical ventilation, length of hospital stay, and antibiotic use being subjected to further examination. Each case was matched with two control patients based on age and date of surgery. The results were analyzed statistically. Results: A total of 36 cases of candidemia were identified and matched with 72 control cases. The incidence of candidemia was found to be 21.8 episodes per 1000 hospital admissions. The median age of patients with candidemia was four months. Candida species were identified in the blood cultures of 36 out of 1650 patients (0.21%). Candida albicans (n = 12, 33.3%), Candida parapsilosis (n = 16, 44.4%), Candida glabrata (n = 2, 5.5%), and other non-albicans Candida species (n = 6, 16.6%) were isolated. The mortality rate associated with Candida bloodstream infections was 61.1% (22\/36). The following independent risk factors were identified as being associated with candidemia: a birth weight of less than 2500 g (OR: 3.2; 95% confidence interval (CI): 2.5\u20135; p = 0.009), a RACHS-1 score of 4 or above (OR: 2.1; 95% CI: 1.3\u20136; p = 0.01), cumulative antibiotic exposure of seven days or more (OR: 2.5; 95% CI: 2\u201310; p &lt; 0.001), duration of central venous catheterization (CVC) of \u226514 days (OR: 6.1; 95% CI: 4\u201318; p &lt; 0.001), mechanical ventilation dependency of \u226510 days (OR: 4.2; 95% CI: 3\u201311; p = 0.01), a requirement for total parenteral nutrition (OR: 9; 95% CI: 6\u201324; p &lt; 0.001), and delayed sternal closure of \u22652 days (OR: 1.8; 95% CI: 1\u20134; p = 0.04). Conclusions: Postoperative candidemia represents a significant complication in pediatric patients with congenital heart disease (CHD), with different Candida species identified as a potential cause. The primary risk factors that contribute to the likelihood of a Candida bloodstream infection in these cases are a low birth weight, a high RACHS-1 score, dependence on mechanical ventilation, prolonged exposure to antibiotics, prolonged central venous catheter duration, delayed sternal closure, and total parenteral nutrition.<\/jats:p>","DOI":"10.3390\/diagnostics15081001","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T09:06:51Z","timestamp":1744621611000},"page":"1001","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Candida Bloodstream Infections and Associated Risk Factors in Pediatric Cardiac Intensive Care"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4284-2225","authenticated-orcid":false,"given":"Onur","family":"Ozalp","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Basaksehir Cam and Sakura Hospital, University of Health Sciences, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1762-3269","authenticated-orcid":false,"given":"Erkut","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Basaksehir Cam and Sakura Hospital, University of Health Sciences, Istanbul 34480, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1016\/j.jacc.2011.08.025","article-title":"Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis","volume":"58","author":"Konings","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1017\/S1047951108003028","article-title":"Nomenclature and databases for the surgical treatment of congenital cardiac disease: An updated primer and an analysis of opportunities for improvement","volume":"18","author":"JaJacobs","year":"2008","journal-title":"Cardiol. Young"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"\u015eanl\u0131, K., Arslanta\u015f, E., Ceylan, A.N., \u00d6ncel, B., \u00d6zkorucu, D., and \u00d6zkan Karagen\u00e7, A. (2024). Candidemia in Pediatric-Clinic: Frequency of Occurrence, Candida Species, Antifungal Susceptibilities, and Effects on Mortality (2020\u20132024). Diagnostics, 14.","DOI":"10.3390\/diagnostics14202343"},{"key":"ref_4","first-page":"94","article-title":"Invasive Fungal Infections in Children with Leukemia: Clinical Features and Prognosis","volume":"39","author":"Baytan","year":"2022","journal-title":"Turk. J. Haematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"580","DOI":"10.5578\/mb.20219709","article-title":"Mortality Risk Factors for Invasive Candidiasis in Pediatric Intensive Care Unit","volume":"55","author":"Korulmaz","year":"2021","journal-title":"Mikrobiyol. Bul."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1111\/bjh.16452","article-title":"Fungal infections in children with haematologic malignancies and stem cell transplant recipients","volume":"189","author":"Otto","year":"2020","journal-title":"Br. J. Haematol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Vasileiou, E., Paisiou, A., Tsipou, C., Pourtsidis, A., Galani, V., Katzilakis, N., Antoniadi, K., Papakonstantinou, E., Ioannidou, E., and Stiakaki, E. (2020). Candidemia in Children with Malignancies: Report from the Infection Working Group of the Hellenic Society of Pediatric Hematology-Oncology. J. Fungi, 6.","DOI":"10.3390\/jof6040276"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1093\/jpids\/pix046","article-title":"Epidemiology of Invasive Fungal Disease in Children","volume":"6","author":"Pana","year":"2017","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1017\/S1047951122000737","article-title":"A 5-year analysis of Candida bloodstream infections in the paediatric cardiovascular surgery ICU of a tertiary care centre","volume":"33","year":"2023","journal-title":"Cardiol. Young"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1097\/INF.0000000000003225","article-title":"Characteristics, Risk Factors and Predictors for Candidemia in the Pediatric Intensive Care Unit at the University Hospital Centre Zagreb in Croatia: A 9-Year Retrospective Study","volume":"40","author":"Matic","year":"2021","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1111\/myc.12792","article-title":"Candidemia in children: Epidemiology, prevention and management","volume":"61","author":"Mantadakis","year":"2018","journal-title":"Mycoses"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/INF.0000000000003847","article-title":"Risk Factors Characteristics of Candidemia After Cardiac Surgery in Pediatric Patients in Central Israel","volume":"42","author":"Kahan","year":"2023","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1086\/599376","article-title":"Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America","volume":"49","author":"Mermel","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1086\/599039","article-title":"Epidemiology and outcomes of candidemia in 2019 patients: Data from the prospective antifungal therapy alliance registry","volume":"48","author":"Horn","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_15","unstructured":"Clinical and Laboratory Standards Institute (2017). Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts, Clinical and Laboratory Standards Institute. [4th ed.]. CLSI Document M27-A4."},{"key":"ref_16","unstructured":"Clinical and Laboratory Standards Institute (2020). Performance Standards for Antifungal Susceptibility Testing of Yeasts, Clinical and Laboratory Standards Institute. CLSI M60-Ed2."},{"key":"ref_17","unstructured":"European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2020). Breakpoint Tables for Interpretation of MICs for Antifungal Agents, European Committee on Antimicrobial Susceptibility Testing (EUCAST). Version 10.0."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.jcrc.2014.11.023","article-title":"Candidemia-induced pediatric sepsis and its association with free radicals, nitric oxide, and cytokine level in host","volume":"30","author":"Kumar","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"H35","DOI":"10.12659\/MSM.881751","article-title":"Candidemia in children after complex congenital heart defects surgery treated with caspofungin\u2014Our own experience and a review of literature","volume":"17","author":"Jaworski","year":"2011","journal-title":"Med. Sci. Monit."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/jpids\/pis066","article-title":"A randomized, controlled trial of catheter-related infectious event rates using antibiotic-impregnated catheters versus conventional catheters in pediatric cardiovascular surgery patients","volume":"2","author":"Cox","year":"2013","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1093\/icvts\/ivw156","article-title":"Fungal infections in children in the early postoperative period after cardiac surgery for congenital heart disease: A single-centre experience","volume":"23","author":"Jaworski","year":"2016","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1097\/INF.0000000000001277","article-title":"Risk Adjustment for Congenital Heart Surgery Score as a Risk Factor for Candidemia in Children Undergoing Congenital Heart Defect Surgery","volume":"35","author":"Lenzi","year":"2016","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.5578\/ced.20239701","article-title":"Evaluation of risk factors in invasive Candida infections in children","volume":"17","author":"Yasa","year":"2023","journal-title":"J. Pediatr. Inf."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.1007\/s42770-023-01163-3","article-title":"The impact of increasing non-albicans Candida trends on diagnostics in immunocompromised patients","volume":"54","author":"Abdelfattah","year":"2023","journal-title":"Braz. J. Microbiol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Arastehfar, A., Hilmio\u011flu-Polat, S., Daneshnia, F., Pan, W., Hafez, A., Fang, W., Liao, W., \u015eahbudak-Bal, Z., Metin, D.Y., and J\u00fanior, J.N.A. (2021). Clonal Candidemia Outbreak by Candida parapsilosis Carrying Y132F in Turkey: Evolution of a Persisting Challenge. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.676177"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.jgar.2019.04.003","article-title":"First multicentre report of in vitro resistance rates in candidaemia isolates in Turkey","volume":"18","author":"Birinci","year":"2019","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"105799","DOI":"10.1016\/j.ijantimicag.2019.09.003","article-title":"Analysis of global antifungal surveillance results reveals predominance of Erg11 Y132F alteration among azole-resistant Candida parapsilosis and Candida tropicalis and country-specific isolate dissemination","volume":"55","author":"Castanheira","year":"2020","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/myc.13050","article-title":"Changing epidemiology of candidaemia: Increase in fluconazole-resistant Candida parapsilosis","volume":"63","author":"Mesini","year":"2020","journal-title":"Mycoses"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1007\/s12098-014-1343-5","article-title":"Risk factors for candidemia in pediatric intensive care unit patients","volume":"81","author":"Devrim","year":"2014","journal-title":"Indian J. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1007\/s42770-020-00232-1","article-title":"Candidemia by Candida parapsilosis in a neonatal intensive care unit: Human and environmental reservoirs, virulence factors, and antifungal susceptibility","volume":"51","author":"Bessa","year":"2020","journal-title":"Braz. J. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1093\/cid\/ciab562","article-title":"The landscape of candidemia during the Coronavirus disease 2019 (COVID-19) pandemic","volume":"74","author":"Seagle","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6808a1","article-title":"Population-Based Active Surveillance for Culture-Confirmed Candidemia\u2014Four Sites, United States, 2012\u20132016","volume":"68","author":"Toda","year":"2019","journal-title":"MMWR Surveill. Summ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s13054-020-2766-1","article-title":"Risk factors for candidemia: A prospective matched case-control study","volume":"24","author":"Poissy","year":"2020","journal-title":"Crit. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1093\/cid\/ciz1061","article-title":"The Changing Epidemiology of Candidemia in the United States: Injection Drug Use as an Increasingly Common Risk Factor-Active Surveillance in Selected Sites, United States, 2014\u20132017","volume":"71","author":"Zhang","year":"2020","journal-title":"Clin. Infect. Dis."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/8\/1001\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:14:21Z","timestamp":1760030061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/8\/1001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["diagnostics15081001"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15081001","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]}}}