Determining risk factors for candidemia among newborn infants from population-based surveillance: Baltimore, Maryland, 1998-2000.
BACKGROUND
Our objective was to determine risks factors for late onset candidemia, independent of birth weight, in newborn infants.


METHODS
We performed a matched case-control study. Cases were identified through active, population-based surveillance for candidemia, conducted in Baltimore City and County during 1998-2000, and were defined as the incident isolation of any Candida species from the bloodstream of an infant 3 months old or younger. Four controls, matched by age, hospital, birth weight category, hospital stay and admission date, were selected for each case. Potential risk factors included clinical, demographic and maternal prenatal data.


RESULTS
Of the 35 cases, 19 (54%) infections were with Candida albicans, 9 (26%) were with Candida parapsilosis and 5 (14%) were with Candida glabrata. Cases had a median birth weight of 680 g (range, 430-3200 g); median gestational ages of cases and controls were 25 and 27 weeks, respectively. Compared with controls, cases had significant higher mortality (20% versus 4%; P = 0.004). No maternal factors were associated with increased risk of disease; cases were as likely as controls to be of black race. Multivariable conditional logistic regression analysis revealed that gestational age younger than 26 weeks [adjusted odds ratio, 6.5; 95% confidence interval (95% CI), 1.3-32], vaginal delivery (adjusted odds ratio, 4.3; 95% CI 1.3-14.2) and abdominal surgery (adjusted odds ratio, 10.9; 95% CI 1.9-62) were independently associated with increased risk of candidemia.


CONCLUSIONS
Independent of birth weight, infants born at <26 weeks or those who have had abdominal surgery are at a significantly increased risk of candidemia. This study helps define a subgroup of preterm infants at high risk of developing bloodstream infections with Candida species.
Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Sharmila S
SS
Shetty
Lee H
LH
Harrison
Rana A
RA
Hajjeh
Tom
T
Taylor
Sara A
SA
Mirza
Alicia Bustamante
AB
Schmidt
Laurie Thomson
LT
Sanza
Kathleen A
KA
Shutt
Scott K
SK
Fridkin
D015142:Baltimore; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D007363:Intensive Care Units, Neonatal; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors