Characteristics and outcome of infants with candiduria in neonatal intensive care - a Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study.
BACKGROUND
There is limited information in the literature on the presentation and prognosis of candidal urinary tract infection (UTI) in infants in the neonatal intensive care unit (NICU).


METHODS
This was a prospective cohort study performed in 13 Canadian NICUs. Infants with candidal UTI without extra-renal candidal infection at presentation were enrolled.


RESULTS
Thirty infants fit the study criteria. Median birth weight and gestational age were 2595 grams (range 575-4255) and 35 weeks (range 24-41) with 10 infants being < 30 weeks gestation. The most common primary underlying diagnosis was congenital heart disease (n = 10). The median age at initial diagnosis was 16 days (range 6-84 days). Renal ultrasonography findings were compatible with possible fungal disease in 15 of the 26 infants (58%) in whom it was performed. Treatment was variable, but fluconazole and either amphotericin B deoxycholate or lipid-based amphotericin B in combination or sequentially were used most frequently. Extra-renal candidiasis subsequently developed in 4 infants. In 2 of these 4 infants, dissemination happened during prolonged courses of anti-fungal therapy. Three of 9 deaths were considered to be related to candidal infection. No recurrences of candiduria or episodes of invasive candidiasis following treatment were documented.


CONCLUSIONS
Candidal UTI in the NICU population occurs both in term infants with congenital abnormalities and in preterm infants, and is associated with renal parenchymal disease and extra-renal dissemination. A wide variation in clinical approach was documented in this multicenter study. The overall mortality rate in these infants was significant (30%). In one third of the deaths, Candida infection was deemed to be a contributing factor, suggesting the need for antifungal therapy with repeat evaluation for dissemination in infants who are slow to respond to therapy.
Robinson
Joan L
JL
Department of Pediatrics, Alberta Children's Hospital Calgary, Alberta, Canada. jr3@ualberta.ca
Davies
H Dele
HD
Barton
Michelle
M
O'Brien
Karel
K
Simpson
Kim
K
Asztalos
Elizabeth
E
Synnes
Anne
A
Rubin
Earl
E
Le Saux
Nicole
N
Hui
Charles
C
Langley
Joanne M
JM
Sauve
Reg
R
de Repentigny
Louis
L
Kovacs
Lajos
L
Tan
Ben
B
Richardson
Susan E
SE
D000935:Antifungal Agents / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
D000935:Antifungal Agents