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Risk factors for persistent candidemia infection in a neonatal intensive care unit and its effect on mortality and length of hospitalization

Journal of Perinatology volume 32, pages 621–625 (2012)Cite this article

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Abstract

Objective:

Candida infections cause substantial morbidity and mortality in neonates. Persistent candidemia has not been associated with increased risk of mortality compared with candidemia of shorter duration. This study sought to determine whether persistent candidemia was associated with increased length of hospitalization or mortality in neonates.

Study Design:

A chart review was conducted of neonates with Candida bloodstream infections (n=37). Demographic, laboratory, pharmacy, nutrition and discharge data were abstracted. Contingency table analysis and logistic regression were used to analyze variables associated with persistent candidemia and mortality. The relationship between length of hospitalization and persistent candidemia was assessed with k-sample equality of medians test.

Result:

Nine patients (24%) had persistent candidemia. Increased time between blood culture draw and initial antifungal therapy was associated with increased incidence of persistent candidemia (P=0.03). Five patients (14%) died before hospital discharge; however, no deaths were attributed to persistent candidemia. Length of hospitalization was not increased with persistent candidemia. A decrease in the ratio of enteral feeding days to hyperalimentation days before collection of the first positive blood culture was significantly associated with an increase in all-cause mortality (P=0.03) and death attributed to candidemia (P=0.04). The risk of all-cause mortality decreased with a history of receiving any enteral feedings before the first positive blood culture (P=0.04), as did death attributed to candidemia (P=0.02).

Conclusion:

A duration of >1 day between the time of blood culture and the initial dose of systemic antifungal treatment places neonates at increased risk for developing persistent candidemia; however, this is not associated with increased mortality.

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Acknowledgements

We would like to thank the Wichita Medical Research & Educational Foundation (WMREF) (Wichita, Kansas, USA) for the grant for data collection for this study. WMREF had no role in the study design, data collection, statistical analysis, interpretation of results, manuscript preparation or decision to submit the manuscript for publication. We would also like to thank Jared Shaw and Paula Delmore for assisting with database interrogation and data collection. Thanks to Cari Schmidt for facilitating the IRB and grant applications.

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Authors and Affiliations

  1. Department of Pediatrics, University of Kansas School of Medicine–Wichita, Wichita, KS, USA

    J A Robinson, H D Pham, B T Bloom & R R Wittler

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  1. J A Robinson
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  2. H D Pham
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  3. B T Bloom
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  4. R R Wittler
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Correspondence to R R Wittler.

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Competing interests

Dr Bloom was a site investigator and Dr Wittler is a contracted follow-up physician for the Duke Clinical Research Institute's Prophylactic Fluconazole Study.

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Robinson, J., Pham, H., Bloom, B. et al. Risk factors for persistent candidemia infection in a neonatal intensive care unit and its effect on mortality and length of hospitalization. J Perinatol 32, 621–625 (2012). https://doi.org/10.1038/jp.2011.162

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