Risk Factors for Candidemia after Congenital Heart Defect Surgery: Results from a Bicenter Case-Control Study

Background: Candidemia is a serious complication in pediatric patients with congenital heart defects (CHD) after open-heart surgery. Data on risk factors for postoperative candidemia in this high-risk population are limited. This study aimed to investigate the predictors of candidemia in patients with CHD who underwent cardiac surgery.

Methods: This retrospective, matched case-control study was conducted in two medical centers from 2004 to 2019. Candidemia cases were matched with 2 control patients without candidemia. Multivariate analyses were conducted to identify risk factors for candidemia after open-heart surgery.

Results: Overall, 105 patients were included in the study. Thirty-five candidemia cases were identified and matched to 70 control cases. Candidemia developed at a median time (interquartile range) of 25 (17.5-35) days after surgery. The median age of candidemia cases was 3 months (range 0.03-113). Candida albicans was the most common isolate (46%), followed by candida parapsillosis (34%). Crude 30-day mortality of candidemia was 40%. Multiple regression analysis identified several independent risk factors including chylothorax (odds ratio [OR]=8.6; 95% CI 2.5-29.3; P <0.01), peritoneal dialysis (OR= 7; 95% CI 1.3-36.9; P =0.02), open chest (OR= 4.5; 95% CI 1.7-11.9; P <0.005), and prior antibiotic exposure (OR=8.6; 95% CI 2.7-27.2; P<0.005).

Conclusions: Postoperative candidemia after pediatric open-heart surgery is an uncommon complication, occurring mostly in young infants. Independent Risk factors include significant underlying conditions, such as chylothorax, peritoneal dialysis, open chest and prior antibiotic exposure. Our results may help to define which high-risk patients should be given prophylactic or presumptive antifungal therapy.