PREVALENCE OF CANDIDA SPECIES IN HOSPITAL-ACQUIRED URINARY-TRACT INFECTIONS IN A NEONATAL INTENSIVE-CARE-UNIT

Objective. To determine the prevalence and clinical features of Candid a species in hospital-acquired urinary tract infections (UTI) in a neo natal intensive care unit. Design. A retrospective study was conducted of hospital-acquired UTI occurring ill infants admitted to a neonatal intensive care unit between January 1, 1989, and June 30, 1995, Hospi tal-acquired infection was defined as one occurring in an infant who w as at least 7 days of age and hospitalized since birth, Urinary tract infection was defined by a urine culture yielding a single organism wi th >1000 colony-forming units/ml from a suprapubic aspiration or >10 0 00 colony-forming units/ml via urethral catheterization. Results. Fift y-seven infants had 60 UTI during the study period, Candida spp, were responsible for 25 of 60 (42%) UTI, The median gestational age of infa nts with candidal UTI was 26 weeks (range, 23 to 37) which was signifi cantly less than that for infants with bacterial UTI, 28 weeks (range, 23 to 40) (P = 0.04). Candidemia was present in 13 of 25 (52%) candid al UTI which was significantly more often than bacteremia with bacteri al UTI, 3 of 35 (8%) (odds ratio, 11.6; 95% confidence interval, 2.8 t o 47.8). The median age of infection for candidal UTI was 34 days (ran ge, 9 to 228), which was significantly earlier than for bacterial UTI, 79 days (range, 7 to 247) (P = 0.003). Renal pelvis fungus balls were present in 7 of 20 (35%) infants with candidal UTI who had renal ultr asound studies. Conclusions. Candida spp, were the pathogens identifie d in 42% of hospital-acquired urinary tract infections in a neonatal i ntensive care unit, Candidemia was associated with 52% of candidal UTI and bacteremia with 8% of bacterial UTI. Candidal UTI occurred signif icantly earlier than bacterial UTI, Renal fungus balls were present in 35% of infants with candidal UTI.