More serious infectious morbidity and mortality associated with simultaneous candidemia and coagulase-negative staphylococcal bacteremia in neonates and in vitro adherence studies between Candida albicans and Staphylococcus epidermidis.
BACKGROUND
Candida species and coagulase-negative staphylococci (CoNS) are common etiologies of hospital acquired bloodstream infection in the neonatal intensive care unit (NICU). Sepsis with either organism may result in serious infectious sequelae and along with other staphylococci are the most common causes of abscess formation in preterm infants. This increased incidence of abscess formation may be in part due to adherence factors of both pathogens.


METHODS
All cases of concurrent positive blood cultures for both Candida species and CoNS were identified from the microbiology database in NICU patients from January 1998 to December 2000 and analyzed for risk factors and outcomes. In vitro co-aggregation studies between Candida albicans and Staphylococcus epidermidis were also performed.


RESULTS
Six premature infants were identified as having concurrent Candida and CoNS bloodstream infections during this time period. Four of the six patients developed end-organ dissemination with abscess or infected thrombus formation. Three of the six patients expired during or after their infection. In vitro, co-aggregation studies did not demonstrate reproducible direct adherence between C. albicans and S. epidermidis.


CONCLUSIONS
Simultaneous bloodstream infection with Candida and CoNS, compared to either one alone, is more likely to predispose to abscess formation, septic thrombophlebitis and mortality. Further studies are needed to examine the pathogenesis of these complex infections.
Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA. Electronic address: dak4r@virginia.edu.
David A
DA
Kaufman
Anesthesiology and Critical Care Medicine, The John's Hopkins University School of Medicine, Baltimore, MD, USA.
Anna T
AT
Brown
Memorial Gulfport Pediatrics, Gulfport, MS, USA.
Kati K
KK
Eisenhuth
Texas Children's Pediatrics, Houston, TX, USA.
Joyce
J
Yue
Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
Leigh B
LB
Grossman
Pathology, Duke University School of Medicine, Durham, NC, USA.
Kevin C
KC
Hazen
D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D002176:Candida albicans / Q000302:isolation & purification / Q000472:pathogenicity*; D058387:Candidemia / Q000175:diagnosis* / Q000382:microbiology; D060085:Coinfection / Q000175:diagnosis* / Q000382:microbiology; D017809:Fatal Outcome; D006801:Humans; D007231:Infant, Newborn; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D013212:Staphylococcus epidermidis / Q000302:isolation & purification / Q000472:pathogenicity*
Bacteremia; Candidemia; Co-infection; Neonates