TY - JOUR
T1 - Risk factors for candidemia in critically ill infants
T2 - A matched case-control study
AU - Feja, Kristina N.
AU - Wu, Fann
AU - Roberts, Kevin
AU - Loughrey, Maureen
AU - Nesin, Mirjana
AU - Larson, Elaine
AU - Della-Latta, Phyllis
AU - Haas, Janet
AU - Cimiotti, Jeannie
AU - Saiman, Lisa
PY - 2005/8
Y1 - 2005/8
N2 - Objective: To determine risk factors for late-onset candidemia among infants in the neonatal intensive care unit (NICU). Study design: We performed a matched case-control study from March 2001 to January 2003 in 2 level III-IV NICUs. Case subjects had candidemia diagnosed more than 48 hours after hospitalization. Control subjects (3 per case) were matched by study site, birth weight, study year, and date of enrollment. Potential risk factors included medical devices, medications, gastrointestinal (GI) pathology (congenital anomalies or necrotizing enterocolitis) and previous bacterial bloodstream infections (BSIs). Results: Forty-five cases of candidemia occurred during the study period and accounted for 15% of BSIs. C. albicans caused 62% of infections (28/45); C. parapsilosis, 31% (14/45). Multivariate analysis revealed that catheter use (odds ratio [OR] = 1.06 per day of use; 95% confidence interval [CI] = 1.02 to 1.10), previous bacterial BSIs (OR = 8.02; 95% CI = 2.76 to 23.30) and GI pathology (OR = 4.57; 95% CI = 1.62 to 12.92) were significantly associated with candidemia. In all, 26/45 cases (58%) of candidemia occurred in infants who would not have qualified for fluconazole prophylaxis according to the Kaufman criteria. Conclusions: We confirmed previous risk factors (catheter-days) and identified novel risk factors (previous BSI and GI pathology) for candidemia in critically ill infants that could guide future targeted antifungal prophylaxis strategies.
AB - Objective: To determine risk factors for late-onset candidemia among infants in the neonatal intensive care unit (NICU). Study design: We performed a matched case-control study from March 2001 to January 2003 in 2 level III-IV NICUs. Case subjects had candidemia diagnosed more than 48 hours after hospitalization. Control subjects (3 per case) were matched by study site, birth weight, study year, and date of enrollment. Potential risk factors included medical devices, medications, gastrointestinal (GI) pathology (congenital anomalies or necrotizing enterocolitis) and previous bacterial bloodstream infections (BSIs). Results: Forty-five cases of candidemia occurred during the study period and accounted for 15% of BSIs. C. albicans caused 62% of infections (28/45); C. parapsilosis, 31% (14/45). Multivariate analysis revealed that catheter use (odds ratio [OR] = 1.06 per day of use; 95% confidence interval [CI] = 1.02 to 1.10), previous bacterial BSIs (OR = 8.02; 95% CI = 2.76 to 23.30) and GI pathology (OR = 4.57; 95% CI = 1.62 to 12.92) were significantly associated with candidemia. In all, 26/45 cases (58%) of candidemia occurred in infants who would not have qualified for fluconazole prophylaxis according to the Kaufman criteria. Conclusions: We confirmed previous risk factors (catheter-days) and identified novel risk factors (previous BSI and GI pathology) for candidemia in critically ill infants that could guide future targeted antifungal prophylaxis strategies.
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U2 - 10.1016/j.jpeds.2005.02.021
DO - 10.1016/j.jpeds.2005.02.021
M3 - Article
C2 - 16126040
AN - SCOPUS:23944499869
SN - 0022-3476
VL - 147
SP - 156
EP - 161
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 2
ER -