Risk factors for candidemia in critically ill infants: a matched case-control study.
OBJECTIVE
To determine risk factors for late-onset candidemia among infants in the neonatal intensive care unit (NICU).


METHODS
We performed a matched case-control study from March 2001 to January 2003 in 2 level III-IV NICUs. Case subjects had candidemia diagnosed more than 48 hours after hospitalization. Control subjects (3 per case) were matched by study site, birth weight, study year, and date of enrollment. Potential risk factors included medical devices, medications, gastrointestinal (GI) pathology (congenital anomalies or necrotizing enterocolitis) and previous bacterial bloodstream infections (BSIs).


RESULTS
Forty-five cases of candidemia occurred during the study period and accounted for 15% of BSIs. C. albicans caused 62% of infections (28/45); C. parapsilosis, 31% (14/45). Multivariate analysis revealed that catheter use (odds ratio [OR]=1.06 per day of use; 95% confidence interval [CI]=1.02 to 1.10), previous bacterial BSIs (OR=8.02; 95% CI=2.76 to 23.30) and GI pathology (OR=4.57; 95% CI=1.62 to 12.92) were significantly associated with candidemia. In all, 26/45 cases (58%) of candidemia occurred in infants who would not have qualified for fluconazole prophylaxis according to the Kaufman criteria.


CONCLUSIONS
We confirmed previous risk factors (catheter-days) and identified novel risk factors (previous BSI and GI pathology) for candidemia in critically ill infants that could guide future targeted antifungal prophylaxis strategies.
Feja
Kristina N
KN
Department of Pediatrics, Columbia University Medical Center, New York, New York 10032, USA.
Wu
Fann
F
Roberts
Kevin
K
Loughrey
Maureen
M
Nesin
Mirjana
M
Larson
Elaine
E
Della-Latta
Phyllis
P
Haas
Janet
J
Cimiotti
Jeannie
J
Saiman
Lisa
L
D002177:Candidiasis / Q000209:etiology*; D016022:Case-Control Studies; D002404:Catheterization / Q000009:adverse effects; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009519:New York City / Q000453:epidemiology; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors