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When to suspect fungal infection in neonates: A clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia.

Publication ,  Journal Article
Benjamin, DK; Ross, K; McKinney, RE; Auten, R; Fisher, RG
Published in: Pediatrics
October 2000

OBJECTIVES: To determine the epidemiology of candidemia in our neonatal intensive care unit; to compare risk factors, clinical presentation, and outcomes for neonates infected with Candida albicans, Candida parapsilosis, and coagulase-negative staphylococcus (CoNS); and to suggest a rational approach to empiric antifungal therapy of neonates at risk for nosocomial infection. DESIGN: Retrospective chart review of all neonatal intensive care unit patients with systemic candidiasis or CoNS infection between January 1, 1995 and July 31, 1998 at Duke University Medical Center. RESULTS: Fifty-one patients were reviewed. Nine of 19 patients infected with C parapsilosis and 5 of 15 patients infected with C albicans died of fungemia. Seventeen neonates had >2 positive cultures for CoNS obtained within 96 hours and 1 died. There was no statistically significant difference in birth weight, gestational age, or age at diagnosis between patient groups; however, candidemic patients had a sevenfold higher mortality rate. Before diagnosis, candidemic patients had greater exposure to systemic steroids, antibiotics, and catecholamine infusions. Of the 51 patients, 32 received third-generation cephalosporins in the 2 weeks before diagnosis and 19 did not. Twenty-nine of the 32 who were treated with third-generation cephalosporins subsequently developed candidemia, while candidemia occurred in only 5 of 19 patients who were not treated with cephalosporins. At the time of diagnosis, candidemic patients were more likely to have required mechanical ventilation and were less likely to be tolerating enteral feeding. Multivariate clustered logistic regression analysis revealed that candidemic patients had more exposure to third-generation cephalosporins. Once the clinician was notified of a positive blood culture for Candida, patients infected with C parapsilosis retained their central catheters longer than patients infected with C albicans. CONCLUSIONS: In this retrospective review, we were able to identify aspects of the clinical presentation and medication history that may be helpful in differentiating between candidemia and CoNS bacteremia. Those key features may be used by clinicians to initiate empiric amphotericin B therapy in premature neonates at risk for nosocomial infections. Prolonged use of third-generation cephalosporins was strongly associated with candidemia. There was no statistically significant difference in the morbidity and mortality between patients infected with C parapsilosis and those infected with C albicans. Observed delays in removal of the central venous catheter may have contributed to finding a mortality rate from C parapsilosis that was higher than was previously reported.

Duke Scholars

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

October 2000

Volume

106

Issue

4

Start / End Page

712 / 718

Location

United States

Related Subject Headings

  • Staphylococcal Infections
  • Risk Factors
  • Retrospective Studies
  • Pediatrics
  • Logistic Models
  • Intensive Care Units, Neonatal
  • Infant, Very Low Birth Weight
  • Infant, Premature, Diseases
  • Infant, Premature
  • Infant, Newborn
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Benjamin, D. K., Ross, K., McKinney, R. E., Auten, R., & Fisher, R. G. (2000). When to suspect fungal infection in neonates: A clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia. Pediatrics, 106(4), 712–718. https://doi.org/10.1542/peds.106.4.712
Benjamin, D. K., K. Ross, R. E. McKinney, R. Auten, and R. G. Fisher. “When to suspect fungal infection in neonates: A clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia.Pediatrics 106, no. 4 (October 2000): 712–18. https://doi.org/10.1542/peds.106.4.712.
Benjamin, D. K., et al. “When to suspect fungal infection in neonates: A clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia.Pediatrics, vol. 106, no. 4, Oct. 2000, pp. 712–18. Pubmed, doi:10.1542/peds.106.4.712.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

October 2000

Volume

106

Issue

4

Start / End Page

712 / 718

Location

United States

Related Subject Headings

  • Staphylococcal Infections
  • Risk Factors
  • Retrospective Studies
  • Pediatrics
  • Logistic Models
  • Intensive Care Units, Neonatal
  • Infant, Very Low Birth Weight
  • Infant, Premature, Diseases
  • Infant, Premature
  • Infant, Newborn