title: Risk factors for Candida infections in a neonatal intensive care unit in Costa Rica.
abstract: OBJECTIVE
  To identify potential risk factors associated with Candida infections and compare these risk factors between patients who both died and survived.
  
  
  METHODS
  A group of patients with positive Candida spp. blood cultures admitted to a neonatal intensive care unit (NICU) in Costa Rica between January 1994 and December 1998. Cases were identified through a computerized search of the microbiology laboratory's database on blood cultures.
  
  
  RESULTS
  One hundred and ten newborns were identified. Sixty-six patients (60%) were male; 46 (62%) were preterm infants. Thirty-seven (34%) patients died. Twenty (54%) of them died within three days of the candidemia diagnosis and 17 had disseminated Candida infection on autopsy. Candida albicans and Candida tropicalis were isolated in 90% and 10% of blood cultures, respectively. Mean +/- SD (range) number of days from admission to NICU to the initial positive blood culture were 13.5 +/- 8.5 (1-30) days. Most patients had at least two positive blood cultures (range 1-8). Median (range) days for the sterilization of blood culture were four (1-25) days. Significant differences in survival were identified in patients with axillary-inguinal lesions, apnea and seizures.
  
  
  CONCLUSIONS
  Invasive fungal infections are frequent in NICU. Future case-control prospective studies should be carried out to confirm the findings from this report.
authors.affiliation: Pediatric Infectious Disease Division, National Children's Hospital, San José, Costa Rica. maluvi@racsa.co.cr
authors.forename: María L
authors.initials: ML
authors.lastname: Avila-Aguero
authors.forename: Alejandro
authors.initials: A
authors.lastname: Canas-Coto
authors.forename: Rolando
authors.initials: R
authors.lastname: Ulloa-Gutierrez
authors.forename: Marco A
authors.initials: MA
authors.lastname: Caro
authors.forename: Braulio
authors.initials: B
authors.lastname: Alfaro
authors.forename: María M
authors.initials: MM
authors.lastname: Paris
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology*; D003364:Costa Rica / Q000453:epidemiology; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine