title: Risk factors for Candida parapsilosis bloodstream infection in a neonatal intensive care unit: a case-control study.
abstract: BACKGROUND
  Candida parapsilosis is increasingly responsible for invasive candidiasis in neonates. This study investigates phenotypic and genotypic features of C. parapsilosis microbial isolates and underlying clinical conditions associated with acquisition of C. parapsilosis in a neonatal intensive care unit (NICU) in Italy.
  
  
  METHODS
  Identification of C. parapsilosis was performed by VITEK® 2 and MALDI TOF and confirmed by analysis of internal transcribed spacer ribosomal DNA sequences. Genotyping was performed by PCR fingerprinting. Antifungal susceptibility of strains was evaluated by microdilution. A case-control study was designed to identify risk factors for C. parapsilosis bloodstream infection.
  
  
  RESULTS
  During the study period (April 2009- April 2012), C. parapsilosis was responsible for 6 umbilical catheter and 11 central catheter-associated bloodstream infection in 17 neonates in the NICU. Molecular typing identified identical fingerprinting profile in all C. parapsilosis isolates from neonates. Fifteen of 17 C. parapsilosis isolates were susceptible to all antifungal drugs, two isolates were resistant to fluconazole and intermediate susceptible to itraconazole. Low birthweight, gestational age and time to exposure to assisted ventilation were risk factors for C. parapsilosis infection in neonates in the NICU at univariate and multivariate analysis.
  
  
  CONCLUSIONS
  C. parapsilosis bloodstream infections in the NICU were caused by a single epidemic clone. Low birthweight, gestational age and time to exposure to invasive devices, with predominance of assisted ventilation, were the clinical conditions associated with C. parapsilosis bloodstream infection in the NICU.
authors.affiliation: Department of Public Health, University of Naples "Federico II", Via S. Pansini n.5, 80131, Naples, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Garzillo
authors.affiliation: Department of Public Health, University of Naples "Federico II", Via S. Pansini n.5, 80131, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Bagattini
authors.affiliation: Department of Public Health, University of Naples "Federico II", Via S. Pansini n.5, 80131, Naples, Italy.
authors.forename: Lidija
authors.initials: L
authors.lastname: Bogdanović
authors.affiliation: Department of Public Health, University of Naples "Federico II", Via S. Pansini n.5, 80131, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Di Popolo
authors.affiliation: Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", Naples, Italy.
authors.forename: Vita Dora
authors.initials: VD
authors.lastname: Iula
authors.affiliation: Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", Naples, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Catania
authors.affiliation: Division of Neonatology, Department of Medical Translational Sciences, University of Naples "Federico II", Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raimondi
authors.affiliation: Department of Public Health, University of Naples "Federico II", Via S. Pansini n.5, 80131, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Triassi
authors.affiliation: Department of Public Health, University of Naples "Federico II", Via S. Pansini n.5, 80131, Naples, Italy. rafzarri@unina.it.
authors.forename: Raffaele
authors.identifier: http://orcid.org/0000-0003-4191-9032
authors.initials: R
authors.lastname: Zarrilli
mesh_terms: D000074429:Candida parapsilosis / Q000302:isolation & purification*; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007558:Italy / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D018570:Risk Assessment; D012307:Risk Factors
keywords: Candida parapsilosis; Healthcare-associated infections; Low birth weight; Neonatal intensive care unit; Risk factor analysis