Systemic candidiasis in extremely low birth weight infants receiving topical petrolatum ointment for skin care: A case-control study

Background and Objective. An increase in the incidence of systemic candidia sis (SC) followed a change in skin care for extremely low birth weight (ELB W) infants in our neonatal intensive care unit (NICU). We sought to determi ne whether the use of topical petrolatum ointment (TPO) for skin care of EL BW infants was associated with risk for SC. Study Design. Case-control study. Setting. A 48-bed NICU in a private hospital in Houston, Texas. Patients. Ten ELBW infants with and 30 without SC admitted to the NICU from December 1, 1997 through July 31, 1998. Methods. ELBW infants with SC were identified using hospital microbiology a nd infectious disease consultation databases. A case was defined as an infa nt weighing less than or equal to 1000 g at birth with Candida spp isolated from a normally sterile body site. Three infants without SC were matched t o each case by birth weight, admission date, and survival to the age of SC onset for the case. Data were collected by retrospective medical record rev iew. Molecular analysis of Candida isolates was performed by karyotyping an d restriction fragment length polymorphism using pulsed-field gel electroph oresis. Results. Case infants had a mean (+/- standard deviation) age of onset of 2 1.5 +/- 24 days. Infants with SC and controls did not differ in birth weigh t, gestational age, or duration of therapy with steroids, antibiotics, insu lin, or total parenteral nutrition. Although cases were more likely to be b orn vaginally and had a longer duration endotracheal intubation than contro ls, these differences were not significant. The odds ratio for skin care wi th TPO in case infants versus control infants was 11 (95% confidence interv al: 1.9-63). Skin care with TPO was discontinued and the incidence of SC de creased to baseline. Several Candida spp and genetic profiles were identifi ed, suggesting that there was not a common source outbreak. Conclusions. We conclude that the use of TPO promoted an increase in the in cidence of SC in ELBW infants. Additional investigation of potential infect ious risks for ELBW infants receiving TPO skin care is warranted.