Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995-2004.
OBJECTIVE
Recent reports suggest that candidemia caused by fluconazole-resistant strains is increasing in certain adult populations. We evaluated the annual incidence of neonatal candidemia and the frequency of disease caused by different species of Candida among neonates in the United States.


METHODS
The study included neonates admitted to 128 NICUs participating in the National Nosocomial Infections Surveillance system from January 1, 1995, to December 31, 2004 (study period).


METHODS
Reports of bloodstream infection (BSI) with Candida spp.; Candida BSIs, patient admissions, patient-days, and central venous catheter days were pooled by birth weight category. The number of Candida BSIs per 100 patients (attack rate) and per 1000 patient-days (incidence density) was determined. Both overall and species-specific rates were calculated; data were pooled over time to determine the differences by birth weight category and by year to determine trends over time.


RESULTS
From the 130,523 patients admitted to NICUs during the study period, there were 1997 Candida spp. BSIs reported. Overall, 1472 occurred in the <1000-g birth weight group. Candida albicans BSIs were most common, followed by Candida parapsilosis, Candida tropicalis, Candida lusitaniae, Candida glabrata, and only 3 Candida krusei. Among neonates <1000 g, incidence per 1000 patient-days decreased from 3.51 during 1995-1999 to 2.68 during 2000-2004 but remained stable among heavier neonates. No increase in infections by species that tend to demonstrate resistance to fluconazole (C glabrata or C krusei) was observed.


CONCLUSIONS
Although Candida BSI is a serous problem among neonates <1000 g, incidence has declined over the past decade, and disease with species commonly resistant to azoles was extremely rare.
Fridkin
Scott K
SK
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia 30333, USA. sfridkin@cdc.gov
Kaufman
David
D
Edwards
Jonathan R
JR
Shetty
Sharmila
S
Horan
Teresa
T
D000935:Antifungal Agents / Q000627:therapeutic use; D001724:Birth Weight; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D025141:Drug Resistance, Fungal; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
D000935:Antifungal Agents; D015725:Fluconazole