title: Risk factors for invasive candidiasis in infants >1500 g birth weight.
abstract: BACKGROUND
  We describe the incidence, risk factors and outcomes of invasive candidiasis in infants >1500 g birth weight.
  
  
  METHODS
  We conducted a retrospective cohort study of infants >1500 g birth weight discharged from 305 neonatal intensive care units in the Pediatrix Medical Group from 2001 to 2010. Using multivariable logistic regression, we identified risk factors for invasive candidiasis.
  
  
  RESULTS
  Invasive candidiasis occurred in 330 of the 530,162 (0.06%) infants. These were documented from positive cultures from ≥1 of these sources: blood (n = 323), cerebrospinal fluid (n = 6) or urine from catheterization (n = 19). Risk factors included day of life >7 (odds ratio [OR]: 25.2; 95% confidence interval: 14.6-43.3), vaginal birth (OR: 1.6 [1.2-2.3]), exposure to broad-spectrum antibiotics (OR: 1.6 [1.1-2.4]), central venous line (OR: 1.8 [1.3-2.6]) and platelet count <50,000/mm (OR: 3.7 [2.1-6.7]). All risk factors had poor sensitivities, low positive likelihood ratios and low positive predictive values. The combination of broad-spectrum antibiotics and low platelet count had the highest positive likelihood ratio (46.2), but the sensitivity of this combination was only 4%. Infants with invasive candidiasis had increased mortality (OR: 2.2 [1.3-3.6]).
  
  
  CONCLUSIONS
  Invasive candidiasis is uncommon in infants >1500 g birth weight. Infants at greatest risk are those exposed to broad-spectrum antibiotics and with platelet counts of <50,000/mm(3).
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Amy H
authors.initials: AH
authors.lastname: Herring
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen-Wolkowiez
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D001724:Birth Weight; D001769:Blood / Q000382:microbiology; D058365:Candidiasis, Invasive / Q000453:epidemiology* / Q000401:mortality; D002555:Cerebrospinal Fluid / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents