title: Outcomes following candiduria in extremely low birth weight infants.
abstract: BACKGROUND
  Candidiasis carries a significant risk of death or neurodevelopmental impairment (NDI) in extremely low birth weight infants (ELBW; <1000 g). We sought to determine the impact of candiduria in ELBW preterm infants.
  
  
  METHODS
  Our study was a secondary analysis of the Neonatal Research Network study Early Diagnosis of Nosocomial Candidiasis. Follow-up assessments included Bayley Scales of Infant Development examinations at 18-22 months of corrected age. Risk factors were compared between groups using exact tests and general linear modeling. Death, NDI, and death or NDI were compared using generalized linear mixed modeling.
  
  
  RESULTS
  Of 1515 infants enrolled, 34 (2.2%) had candiduria only. Candida was isolated from blood only (69 of 1515 [4.6%]), cerebrospinal fluid (CSF) only (2 of 1515 [0.1%]), other sterile site only (not urine, blood, or CSF; 4 of 1515 [0.3%]), or multiple sources (28 of 1515 [2%]). Eleven infants had the same Candida species isolated in blood and urine within 3 days; 3 (27%) had a positive urine culture result first. Most urine isolates were Candida albicans (21 of 34 [62%]) or Candida parapsilosis (7 of 34 [29%]). Rate of death or NDI was greater among those with candiduria (50%) than among those with suspected but not proven infection (32%; odds ratio, 2.5 [95% confidence interval, 1.2-5.3]) after adjustment. No difference in death and death or NDI was noted between infants with candiduria and those with candidemia.
  
  
  CONCLUSIONS
  These findings provide compelling evidence that ELBW infants with candiduria are at substantial risk of death or NDI. Candiduria in ELBW preterm infants should prompt a systemic evaluation (blood, CSF, and abdominal ultrasound) for disseminated Candida infection and warrants treatment.
authors.affiliation: Department of Pediatrics, Duke University, Durham, NC 27715, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Wynn
authors.forename: Sylvia
authors.initials: S
authors.lastname: Tan
authors.forename: Marie G
authors.initials: MG
authors.lastname: Gantz
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Goldberg
authors.forename: Ira
authors.initials: I
authors.lastname: Adams-Chapman
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Auten
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Miller
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
mesh_terms: D002175:Candida / Q000145:classification*; D002177:Candidiasis / Q000097:blood / Q000134:cerebrospinal fluid / Q000473:pathology / Q000652:urine*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors