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

Abstract

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.

Clinical and molecular characteristics of bloodstream infections caused by Candida albicans in children from 2003 to 2011

“…It is noticeable that the children with C. albicans BSI M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 14 in the present study almost had previous antibiotic exposure, long-term hospitalization, or a catheter or artificial device in place. These findings are consistent with those previously reported, in which retained intravascular catheters, intestinal failure, presence of gastrostomy tube, and/or receipt of TPN were identified as independent risk factors of candidemia [5,8,11,12,36].…”

“…Risk factors for children with candidemia include intravenous catheter placement with parenteral nutrition, abdominal surgery, steroid usage and exposure to broad-spectrum antibiotics [11][12][13][14][15].…”

The Epidemiology and Diagnosis of Invasive Candidiasis Among Premature Infants

“…2, 4, 15 The incidence of invasive candidiasis is low (0.06%) among infants admitted to the NICU with birth weight >1500 g. 36 In comparison, invasive candidiasis develops in 2–5% of VLBW infants, while 4–16% of ELBW infants have historically been affected. 2, 6, 15, 37–39 The incidence of invasive candidiasis is inversely related to birth weight even among ELBW infants, with infants born at <750 g being at least twice as likely to develop invasive candidiasis as infants with birth weights between 751 and 1000 g. 2, 15 Mortality from invasive candidiasis is also inversely related to birth weight, approaching 50% for infants <750 g. 10 …”

Neonatal Candidiasis: New Insights into an Old Problem at a Unique Host-Pathogen Interface

“…Candida likely gains access to the intravascular space by translocation through the intestinal epithelium. Therefore, GI pathology such as necrotizing enterocolitis or other congenital intestinal anomalies confer additional risk for invasive disease in colonized neonates secondary to compromise of the GI mucosal integrity [16, 17]. …”