title: Risk factors for persistent candidemia infection in a neonatal intensive care unit and its effect on mortality and length of hospitalization.
abstract: OBJECTIVE
  Candida infections cause substantial morbidity and mortality in neonates. Persistent candidemia has not been associated with increased risk of mortality compared with candidemia of shorter duration. This study sought to determine whether persistent candidemia was associated with increased length of hospitalization or mortality in neonates.
  
  
  METHODS
  A chart review was conducted of neonates with Candida bloodstream infections (n=37). Demographic, laboratory, pharmacy, nutrition and discharge data were abstracted. Contingency table analysis and logistic regression were used to analyze variables associated with persistent candidemia and mortality. The relationship between length of hospitalization and persistent candidemia was assessed with k-sample equality of medians test.
  
  
  RESULTS
  Nine patients (24%) had persistent candidemia. Increased time between blood culture draw and initial antifungal therapy was associated with increased incidence of persistent candidemia (P=0.03). Five patients (14%) died before hospital discharge; however, no deaths were attributed to persistent candidemia. Length of hospitalization was not increased with persistent candidemia. A decrease in the ratio of enteral feeding days to hyperalimentation days before collection of the first positive blood culture was significantly associated with an increase in all-cause mortality (P=0.03) and death attributed to candidemia (P=0.04). The risk of all-cause mortality decreased with a history of receiving any enteral feedings before the first positive blood culture (P=0.04), as did death attributed to candidemia (P=0.02).
  
  
  CONCLUSIONS
  A duration of >1 day between the time of blood culture and the initial dose of systemic antifungal treatment places neonates at increased risk for developing persistent candidemia; however, this is not associated with increased mortality.
authors.affiliation: Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Robinson
authors.forename: H D
authors.initials: HD
authors.lastname: Pham
authors.forename: B T
authors.initials: BT
authors.lastname: Bloom
authors.forename: R R
authors.initials: RR
authors.lastname: Wittler
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001724:Birth Weight; D058387:Candidemia / Q000188:drug therapy / Q000401:mortality*; D005865:Gestational Age; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D012189:Retrospective Studies; D012307:Risk Factors; D061665:Time-to-Treatment
chemical_list: D000935:Antifungal Agents