Trends in Candida central line-associated bloodstream infections among NICUs, 1999-2009.
OBJECTIVE
To assess trends in incidence of Candida spp. central line-associated bloodstream infections (CLABSIs) in US NICUs, 1999-2009.


METHODS
Data from NICUs participating in the National Nosocomial Infections Surveillance (1999-2004) and National Healthcare Safety Network (2006-2009) were analyzed. Overall and birth weight-specific incidence rates of Candida spp. CLABSIs per 1000 central line-days were calculated. Trends in incidence were assessed by using Poisson regression, and trends in proportion of CLABSIs identified as Candida albicans were assessed by using weighted-linear regression.


RESULTS
Overall, 398 NICUs reported 1407 Candida spp. CLABSIs (706 due to C albicans) among 1400 neonates. Of the 1400 neonates, 963 (69%) were ≤ 1000 g at the time of birth, and 182 (13%) died. From 1999 to 2009, the overall incidence decreased significantly for CLABSIs due to Candida spp. (0.92 vs 0.2), C albicans (0.53 vs 0.09), and non-albicans Candida spp. (0.39 vs 0.1). Birth weight-specific incidence significantly decreased across all birth weight categories for C albicans. For CLABSIs due to non-albicans Candida spp., significant decreases were detected among all birth weight categories, except among neonates 1501 to 2500 g. The proportion of Candida spp. CLABSIs due to C albicans did not significantly change over time, remaining at ~50%.


CONCLUSIONS
Incidence of Candida spp. CLABSIs decreased substantially among NICU patients, regardless of birth weight. Decreases in incidence across all birth weight categories, and not only among neonates ≤ 1000 g in whom antifungal prophylaxis may be more common, suggest that multiple factors contributed to the declining incidence.
Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. achitnis@cdc.gov
Amit S
AS
Chitnis
Shelley S
SS
Magill
Jonathan R
JR
Edwards
Tom M
TM
Chiller
Scott K
SK
Fridkin
Fernanda C
FC
Lessa
D001724:Birth Weight; D002176:Candida albicans; D058387:Candidemia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000706:statistics & numerical data / Q000639:trends; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D017053:Infection Control; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data* / Q000639:trends; D016014:Linear Models; D016012:Poisson Distribution; D011159:Population Surveillance; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology