Background. Candida species are important nosocomial pathogens in neonatal
intensive care unit (NICU) patients,
Methods, A prospective cohort study was per formed in six geographically di
verse NICUs from 1993 to 1995 to determine the incidence of and risk factor
s for candidemia, including the role of gastrointestinal (GI) tract coloniz
ation. Study procedures included rectal swabs to detect fungal colonization
and active surveillance to identify risk factors for candidemia, Candida s
trains obtained from the GI tract and blood were analyzed by pulsed field g
el electrophoresis to determine whether colonizing strains caused candidemi
a.
Results. In all, 2847 infants were enrolled and 35 (1.2%) developed candide
mia (12.3 cases per 1000 patient discharges or 0.63 case per 1000 catheter
days) including 23 of 421 (5.5%) babies less than or equal to 1000 g, After
adjusting for birth weight and abdominal surgery, forward multivariate log
istic regression analysis demonstrated significant risk factors, including
gestational age <32 weeks, 5-min Apgar <5; shock, disseminated intravascula
r coagulopathy, prior use of intralipid, parenteral nutrition, central veno
us catheters, H2 blockers, intubation or length of stay >7 days before cand
idemia (P < 0.05), Catheters, steroids and GI tract colonization were not i
ndependent risk factors, but GI tract colonization preceded candidemia in 1
5 of 35 (43%) case patients.
Conclusions. Candida spp. are an important cause of late onset sepsis in NI
CU patients. The incidence of candidemia might be decreased by the judiciou
s use of treatments identified as risk factors and avoiding H2 blockers.