Candidal and bacterial bloodstream infections in premature neonates: a cease-control study

Nosocomial bloodstream infections (BSI) in premature neonates are an import ant cause of morbidity and mortality. The early and efficient diagnosis of a neonatal BSI and the differentiation between bacterial and fungal BSI rem ains a challenging task. We compared the clinical features and blood test r esults in preterm infants with proven candidal or bacterial BSI in order to identify potential risk factors for developing a candidal BSI. Preterm inf ants with proven candidal BSI were significantly more prematurely born (mea n age of gestation 27.7 vs. 29.8 weeks), had previously received significan tly more antibiotics of multiple classes (mean 4.4 vs. 1.2) for significant ly longer periods (mean 19.3 vs. 3.2 days), were ventilated more intensivel y, had a significantly longer stay at the neonatal intensive care unit befo re the onset of the BSI (mean 26.5 vs. 9.4 days), and had C-reactive protei n values even higher than in preterm infants with a bacterial BSI (mean 90 vs. 71 mg 1(-1)). The presence of thrombocytopenia (< 150 x 10(9) cells 1(- 1)) in all the preterm infants with candidal BSI was a significant differen ce. No differences were seen with regard to birth-weight, use of central in travascular catheters, total parenteral nutrition, white blood cell count a nd differentiation. In conclusion, candidal BSI can be strongly expected af ter the third week of admittance in the most premature neonates on a respir ator and treated with multiple classes of antibiotics for a prolonged perio d of time. The presence of these risk factors in a 'septic' premature infan t on antibiotic treatment justifies the empiric use of antifungals.