Risk factors associated with candidaemia in the neonatal intensive care unit: a case–control study

Linder, Nehama; Levit, Orly; Klinger, G; Kogan, I.Yu.; Levy, Itzhak; Shalit, Itamar; Ashkenazi, Shai; Sirota, Lea

doi:10.1016/j.jhin.2004.04.010

Cited by 20 publications

(9 citation statements)

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“…This is analogous to findings in premature infant studies: earlier single-center studies reported ventilation and inotropes as risk factors for premature infants and invasive candidiasis, but subsequent multicenter studies did not report such a strong association. 3,11,18 These differences may be due to differences in definitions used in our study compared with previous studies. We defined mechanical ventilation as support on the day that cultures were drawn, and we did not include intubation and mechanical ventilation events prior to the drawing of blood cultures.…”

Section: Discussionmentioning

confidence: 67%

Risk Factors for Invasive Candidiasis in Infants >1500 g Birth Weight

Lee¹,

Hornik²,

Benjamin³

et al. 2013

Pediatric Infectious Disease Journal

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Background We describe the incidence, risk factors, and outcomes of invasive candidiasis in infants >1500 g birth weight. Methods We conducted a retrospective cohort study of infants >1500 g birth weight discharged from 305 NICUs in the Pediatrix Medical Group from 2001–2010. Using multivariable logistic regression, we identified risk factors for invasive candidiasis. Results Invasive candidiasis occurred in 330/530,162 (0.06%) infants. These were documented from positive cultures from ≥1 of these sources: blood (n=323), cerebrospinal fluid (n=6), or urine from catheterization (n=19). Risk factors included day of life >7 (OR 25.2; 95% CI 14.6–43.3), vaginal birth (OR 1.6 [1.2–2.3]), exposure to broad-spectrum antibiotics (OR 1.6 [1.1–2.4]), central venous line (OR 1.8 [1.3–2.6]), and platelet count <50,000/mm3 (OR 3.7 [2.1–6.7]). All risk factors had poor sensitivities, low positive likelihood ratios, and low positive predictive values. The combination of broad-spectrum antibiotics and low platelet count had the highest positive likelihood ratio (46.2), but the sensitivity of this combination was only 4%. Infants with invasive candidiasis had increased mortality (OR 2.2 [1.3–3.6]). Conclusions Invasive candidiasis is uncommon in infants >1500 g birth weight. Infants at greatest risk are those exposed to broad-spectrum antibiotics and with platelet counts of <50,000/mm3.

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Section: Discussionmentioning

confidence: 67%

Risk Factors for Invasive Candidiasis in Infants >1500 g Birth Weight

Lee¹,

Hornik²,

Benjamin³

et al. 2013

Pediatric Infectious Disease Journal

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“…70 The duration of ventilation was also related to the acquisition of HAI. 71 Reuse of single-use items, a common though unsound practice in many units, has led to outbreaks of HAI. Endotracheal tubes and mucous extraction suction catheters soaked in Hibitane were associated with HAI in the labour room and the special care baby unit.…”

Section: Risk Factors For Hais In Neonatesmentioning

confidence: 99%

Healthcare-associated infections in neonatal units: lessons from contrasting worlds

Srivastava

Shetty

2007

Journal of Hospital Infection

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Neonatal intensive care units are vulnerable to outbreaks and sporadic incidents of healthcare-associated infections (HAIs). The incidence and outcome of these infections are determined by the degree of immaturity of the neonatal immune system, invasive procedures involved, the aetiological agent and its antimicrobial susceptibility pattern and, above all, infection control policies practised by the unit. It is important to raise awareness of infection control practices in resource-limited settings, since overdependence upon antimicrobial agents and co-existing lack of awareness of infection control is encouraging the emergence of multi-drug-resistant nosocomial pathogens. We reviewed 125 articles regarding HAIs from both advanced and resource-limited neonatal units in order to study risk factors, aetiological agents, antimicrobial susceptibility patterns and reported successes in infection control interventions. The articles include surveillance studies, outbreaks and sporadic incidents. Gram-positive cocci, viruses and fungi predominate in reports from the advanced units, while Gram-negative enteric rods, non-fermenters and fungi are commonly reported from resource-limited settings. Antimicrobial susceptibility patterns from surveillance studies determined the empirical therapy used in each neonatal unit. Most outbreaks, irrespective of the technical facilities available, were traced to specific lack of infection control practices. We discuss infection control interventions, with special emphasis on their applicability in resource-limited settings. Cost-effective measures for implementing these interventions, with particular reference to the recognition of the role of the microbiologist, the infection control team and antibiotic policies are presented.

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“…In contrast, other studies found that steroid therapy was not associated with risk of developing candidaemia (Blumberg et al 2001;Cheng et al 2006). In fact, maternal steroid was found to be an independent protective factor against candidaemia in neonates (Linder et al 2004). However, the exact mechanism is unclear.…”

Section: Discussionmentioning

confidence: 99%