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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3182769603
Original Studies

Risk Factors for Invasive Candidiasis in Infants >1500 g Birth Weight

Lee, Jan Hau MB BS, MRCPCH*†‡; Hornik, Christoph P. MD, MPH*†; Benjamin, Daniel K. Jr. MD, PhD, MPH*†; Herring, Amy H. ScD§; Clark, Reese H. MD; Cohen-Wolkowiez, Michael MD*†; Smith, P. Brian MD, MPH, MHS*†

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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/mm3 (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/mm3.

© 2013 Lippincott Williams & Wilkins, Inc.

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