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Objective: To determine risk factors for late-onset candidemia among infants in the neonatal intensive care unit (NICU). Study design: We performed a matched case-control study from March 2001 to January 2003 in 2 level III-IV NICUs. Case s ubjects had candidemia diagnosed more than 48 hours after hospitalization. Contr ol subjects (3 per case) were matched by study site, birth weight, study year, a nd date of enrollment. Potential risk factors included medical devices, medicati ons, gastrointestinal (GI) pathology (congenital anomalies or necrotizing entero colitis) and previous bacterial bloodstream infections (BSIs). Results: Forty-f ive cases of candidemia occurred during the study period and accounted for 15%o f BSIs. C. albicans caused 62%of infections (28/45); C. parapsilosis, 31%(14/4 5). Multivariate analysis revealed that catheter use (odds ratio [OR] = 1.06 per day of use; 95%confidence interval [CI] = 1.02 to 1.10), previous bacterial BS Is (OR = 8.02; 95%CI = 2.76 to 23.30) and GI pathology (OR = 4.57; 95%CI = 1.6 2 to 12.92)were significantly associated with candidemia. In all, 26/45 cases (5 8%) of candidemia occurred in infants who would not have qualified for fluconaz ole prophylaxis according to the Kaufman criteria. Conclusions: We confirmed pre vious risk factors (catheter-days) and identified novel risk factors (previous BSI and GI pathology) for candidemia in critically ill infants that could guide future targeted antifungal prophylaxis strategies.
Objective: To determine risk factors for late-onset candidemia among infants in the neonatal intensive care unit (NICU). Study design: We performed a matched case-control study from March 2001 to January 2003 in 2 level III-IV NICUs. Case s ubjects had candidemia diagnosed more than 48 hours after hospitalization. Contr ol subjects (3 per case) were matched by study site, birth weight, study year, a nd date of enrollment. Potential risk factors included medical devices, medicati ons, gastrointestinal Results pathology (congenital anomalies or necrotizing entero colitis) and previous bacterial bloodstream infections (BSIs). Results: Forty-f ive cases of candidemia occurred during the study period and accounted for 15% of BSIs. C. albicans caused 62% of infections Multivariate analysis revealed that catheter use (odds ratio [OR] = 1.06 per day of use; 95% confidence interval [CI] = 1.02 to 1.10), previous bacterial BS Is (OR = 8.02; 95% CI = 2.76 to 23.30 ) and GI pathology (OR = 4.57; 95% CI = 1.6 2 to 12.92) were significantly associated with candidemia. In all, 26/45 cases (58%) of candidemia occurred in infants who would not have qualified for fluconaz ole prophylaxis according to the Kaufman criteria. Conclusions: We confirmed previous risk factors (catheter-days) and identified novel risk factors (previous BSI and GI pathology) for candidemia in critically ill infants that could guide future targeted antifungal prophylaxis strategies.