CANDIDEMIA IN A NEONATAL INTENSIVE-CARE UNIT - TRENDS DURING 15 YEARSAND CLINICAL-FEATURES OF 111 CASES

Objective. To determine changes in the incidence of candidemia in a ne onatal intensive care unit (NICU) during a 15-year period (1981 to 199 5) and to compare the prevalence and case fatality rates of Candida al bicans and Candida parapsilosis infections. Methods. A retrospective s tudy was conducted of candidemia occurring in infants in a NICU betwee n January 1, 1981, and December 31, 1995. Cases were identified throug h computerized searching of a microbiology blood culture database. Can didemia was considered contributory to mortality if death occurred wit hin 3 days of positive blood cultures or if there was autopsy evidence of disseminated candidiasis. Results. One hundred eleven cases of can didemia occurred in 107 infants, representing 1% of all NICU patients during the study period. The rate of candidemia in the NICU increased from 2.5 cases per 1000 admissions in 1981 to 1985, to 4.6 per 1000 ad missions in 1986 to 1990 and to 28.5 per 1000 in 1991 to 1995 (P = 0.0 01). C. albicans was the predominant cause of candidemia between 1981 and 1990, C. parapsilosis was the most prevalent species between 1991 and 1995, causing 53 of 89 cases (60%), The mortality from C. albicans , 13 of 50 cases (26%), was significantly higher than the mortality fr om C. parapsilosis, 2 of 54 (4%) (P = 0.002; relative risk, 7; 95% con fidence interval, 1.7 to 30). Conclusions. The rate of candidemia in o ur neonatal intensive care unit increased >11-fold in the 15 years fro m 1981 to 1995; the prevalent Candida species shifted from C. albicans to C. parapsilosis; and candidemia associated with C. albicans has si gnificantly higher mortality than with C. parapsilosis.