Risk factors for candidemia in neonatal intensive care unit patients

Citation
L. Saiman et al., Risk factors for candidemia in neonatal intensive care unit patients, PEDIAT INF, 19(4), 2000, pp. 319-324
Citations number
32
Categorie Soggetti
Clinical Immunolgy & Infectious Disease
Journal title
PEDIATRIC INFECTIOUS DISEASE JOURNAL
ISSN journal
08913668 → ACNP
Volume
19
Issue
4
Year of publication
2000
Pages
319 - 324
Database
ISI
SICI code
0891-3668(200004)19:4<319:RFFCIN>2.0.ZU;2-T
Abstract
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.