The association of third-generation cephalosporin use and invasive candidiasis in extremely low birth-weight infants.
OBJECTIVE
Previous studies have shown that incidence of invasive candidiasis varies substantially among centers, and previous use of broad-spectrum antibiotics is a risk factor for candidiasis in extremely low birth-weight infants. Differences in center practices, such as antibiotic strategies and the effects of these strategies on center incidence of candidiasis, are not reflected in assessments of an individual's risk of candidiasis. We evaluated the relationship between empirical antibiotic practices for extremely low birth-weight infants and center incidence of candidiasis.


METHODS
We studied a cohort of extremely low birth-weight infants who survived > or = 72 hours and were admitted to 1 of 12 tertiary centers between 1998 and 2001. Multivariable logistic regression was used to validate previous broad-spectrum antibiotics use as a risk factor for subsequent candidiasis in individual infants. We calculated correlation coefficients to assess the relationship between center incidence of candidiasis with antibiotic practice patterns.


RESULTS
There were 3702 infants from 12 centers included, and 284 (7.7%) developed invasive candidiasis. Broad-spectrum antibiotics use was associated with candidiasis for individual infants. Center candidiasis incidence ranged from 2.4% to 20.4%. Center incidence of candidiasis was correlated with average broad-spectrum antibiotics use per infant and average use of broad-spectrum antibiotics with negative cultures per infant.


CONCLUSIONS
Center incidences of invasive candidiasis differ substantially, and antibiotic practice differences are possible contributors to center variation in candidiasis risk.
Cotten
C Michael
CM
Duke University Department of Pediatrics, Durham, North Carolina 27710, USA. cotte010@mc.duke.edu
McDonald
Scott
S
Stoll
Barbara
B
Goldberg
Ronald N
RN
Poole
Kenneth
K
Benjamin
Daniel K
DK
D001769:Blood / Q000382:microbiology; D002177:Candidiasis / Q000453:epidemiology* / Q000209:etiology; D015780:Carbapenems / Q000627:therapeutic use*; D002405:Catheterization, Central Venous; D020314:Central Nervous System Fungal Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D002511:Cephalosporins / Q000145:classification / Q000627:therapeutic use*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D016469:Fungemia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000209:etiology; D019102:Infant, Very Low Birth Weight; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D015163:Superinfection / Q000453:epidemiology* / Q000209:etiology
D015780:Carbapenems; D002511:Cephalosporins