title: Persistent candidemia in neonatal care units: risk factors and clinical significance.
abstract: OBJECTIVE
  The prevalence and clinical significance of persistent candidemia among neonates are poorly understood. This study aimed to describe the rate and the clinical relevance of persistent candidemia over a 4-year period in Kuwait.
  
  
  METHODS
  A retrospective chart review of infants admitted to the Neonatal Care Unit of the Maternity Hospital in Kuwait between January 2007 and December 2010, who had a positive blood culture for Candida species, was conducted. Persistent candidemia was defined as the isolation of the same Candida species more than 6 days after the initiation of antifungal therapy, or death due to candidemia within 6 days of antifungal treatment. Stepwise logistic regression was used to investigate factors associated with persistent candidemia.
  
  
  RESULTS
  Of 89 neonates with a Candida infection, 54 (60.7%, 95% confidence interval 49.7-70.9%) had persistent candidemia. The case-fatality rate was 54% among those with persistent candidemia and 3% among those with non-persistent candidemia (p<0.001). Neonates with persistent candidemia were more likely to be female, have a central vascular catheter at diagnosis, and have a low platelet count. All isolated Candida species were susceptible to antifungal agents.
  
  
  CONCLUSIONS
  Persistent candidemia is common among neonates with a Candida infection and is associated with an increased risk of mortality. Drug resistance is unlikely to explain the persistent candidemia; host-related factors seem to be more important and hence could be used to identify those at risk in order to institute appropriate preventive and treatment measures.
authors.affiliation: Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait. m.hammoud@hsc.edu.kw
authors.forename: Majeda S
authors.initials: MS
authors.lastname: Hammoud
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Taiar
authors.forename: Mervat
authors.initials: M
authors.lastname: Fouad
authors.forename: Aditiya
authors.initials: A
authors.lastname: Raina
authors.forename: Ziauddin
authors.initials: Z
authors.lastname: Khan
mesh_terms: D002175:Candida / Q000145:classification / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007730:Kuwait; D008297:Male; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors