Objective: To determine clinical features and time trend of candidemia in a neonatal intensive care unit (NICU) over a 15 year period (1981-95).

Design: A retrospective study of candidemia occurring in infants in a NICU between 1/1/81 and 12/31/95 was conducted. Cases occurring in 1/81-6/88 were identified from nosocomial infection reports. Cases from 7/88-12/95 were identified from the microbiology blood culture database. Candidemia was considered contributory to mortality if death occurred within 3 days of positive blood cultures.

Results: There were 612 ± 14 (mean ± SEM) admissions to the NICU annually. One hundred nine cases of candidemia occurred in 106 infants. The median birth weight of infants with candidemia was 768 g (range 480-4285) and median gestational age was 26 wk (range 23-41). Blood cultures remained positive for a median of 4 days (range 1-28). The rate of candidemia in the NICU increased from medians of 1.8 cases per 1,000 admissions in 1981-85, to 4.9 per 1,000 in 1986-90, to 28.6 per 1,000 in 1991-95; showing a significant time trend (p=.008). The most common species were C. parapsilosis in 53 cases (49%) and C. albicans in 50 (46%). C. albicans was the only cause of candidemia in 1981-90. C. parapsilosis was the most prevalent species in 1991-95, 53 of 89 cases (60%). The mortality from C. parapsilosis was 2 of 53 (4%) which was significantly lower than mortality from C. albicans: 11 of 50 cases (22%), p=.007. There was no significant difference in birth weight or gestational age among infants with C. albicans and C. parapsilosis. Six of 11 infants who died from candidemia caused by C. albicans were from 1991-95.

Conclusions: 1) The rate of candidemia in the NICU has increased more than 15-fold in the fifteen years from 1981-95; 2)Candida parapsilosis was the most prevalent species causing candidemia in 1991-95; and 3) Candidemia associated with Candida parapsilosis had a lower mortality than candidemia with Candida albicans.