1405 Risk Factors for Candidemia in a Neonatal Intensive Care Unit

Abstract

Introduction: Candidiasis are important nosocomial infections in Neonatal Intensive Care Units (NICU) associated with prolonged morbidity and significant hospital costs. The incidence is reported as 2 - 6.8% among VLBW and 4-16%, among ELBW. The mortality rates is reported to be 30 to 60%. Objective: to identify the risk factors and clinical outcome associated with candidaemia. Methods: retrospective study of all cases of fungal infections in our NICU between 2003 and 2009. Results: 48 newborns were infected by Candida spp; 17/48 (35.4%) developed sepsis, 1/17 developed meningitis. Median GA was 25 + 3 wks (23 - 35 wks). 12/17 (70%) were < 28 wks. Median BW was 893 g (433-2050 g). 13/17 (76%) were < 1000 g. Isolated fungi were Candida Albicans (94%) and Candida Glabrata (6%). At univariate analysis, CVC (OR 69.5; p< 0.001), CVO (OR 31.5; p< 0.001), cephalosporin (OR 3.4; p=0.05), H2 antagonist (OR 6.6; p=0.004), lipid emulsions (OR 110.0; p< 0.001), ventilation (OR 17.5; p< 0.001) were associated with sepsis. At multivariate analysis, ventilation and CVC remained significantly associated (OR 19.8 and 23.1 p=0.021 and p=0.005 respectively). 8/17 (46%) developed ROP, 1/17 (6%) NEC, 3/17 (17%) IVH. Median hospitalization was 91 days, median age at diagnosis was 20 days. 1/17 newborns died (6%). All infants received liposomal amphotericin for a median time of 20 days. Conclusions: ventilation, central vascular catheters, third generation cephalosporins, H2 antagonist, lipid emulsions are significant risk factors for neonatal acquired candidemia. The incidence might be decreased by the judicious use of treatments identified as risk factors.