Risk Factors for Fungemia in Children Infected with Human Immunodeficiency Virus: A Case-Control Study

To define the risk factors related to the occurrence of fungemia in children infected with human immunodeficiency virus (HIV), we performed a matched case-control study. During a 6-year period (1987–1993), fungemia developed in 22 (6.3%)of 347 HIV-infected children observed at the Pediatric Branch of the National Cancer Institute. Each of these 22 cases was matched by age and gender with three controls. Multiple logistic regression indicated that the best predictor of fungemia in this population was the presence of a central venous catheter placed for >90 days (P < .00001),followed by a group of risk factors composed of 10 independent variables adjusted for a CD4 cell count of < 100/μL (P < .045). Those variables included treatment with more than three antibiotics, treatment with more than three parenteral antibiotics, > 30 days of antibiotic treatment, bacterial infections, >30 days in the hospital, hypoalbuminemia, C3 (Centers for Disease Control and Prevention) classification of HIV infection, and malnourishment. We conclude that prolonged placement of central venous catheters is the most important risk factor for fungemia in HIV-infected children and that the risk of fungemia is further influenced by antibacterial therapy, catheter manipulation, and host response.