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. 2012 Feb 1;54(3):331-9.
doi: 10.1093/cid/cir800. Epub 2011 Dec 5.

Outcomes following candiduria in extremely low birth weight infants

James L Wynn  1 , Sylvia Tan, Marie G Gantz, Abhik Das, Ronald N Goldberg, Ira Adams-Chapman, Barbara J Stoll, Seetha Shankaran, Michele C Walsh, Kathy J Auten, Nancy A Miller, Pablo J Sánchez, Rosemary D Higgins, C Michael Cotten, P Brian Smith, Daniel K Benjamin Jr; NICHD Neonatal Research Network
Collaborators, Affiliations

Outcomes following candiduria in extremely low birth weight infants

James L Wynn et al. Clin Infect Dis. .

Abstract

Background: Candidiasis carries a significant risk of death or neurodevelopmental impairment (NDI) in extremely low birth weight infants (ELBW; <1000 g). We sought to determine the impact of candiduria in ELBW preterm infants.

Methods: Our study was a secondary analysis of the Neonatal Research Network study Early Diagnosis of Nosocomial Candidiasis. Follow-up assessments included Bayley Scales of Infant Development examinations at 18-22 months of corrected age. Risk factors were compared between groups using exact tests and general linear modeling. Death, NDI, and death or NDI were compared using generalized linear mixed modeling.

Results: Of 1515 infants enrolled, 34 (2.2%) had candiduria only. Candida was isolated from blood only (69 of 1515 [4.6%]), cerebrospinal fluid (CSF) only (2 of 1515 [0.1%]), other sterile site only (not urine, blood, or CSF; 4 of 1515 [0.3%]), or multiple sources (28 of 1515 [2%]). Eleven infants had the same Candida species isolated in blood and urine within 3 days; 3 (27%) had a positive urine culture result first. Most urine isolates were Candida albicans (21 of 34 [62%]) or Candida parapsilosis (7 of 34 [29%]). Rate of death or NDI was greater among those with candiduria (50%) than among those with suspected but not proven infection (32%; odds ratio, 2.5 [95% confidence interval, 1.2-5.3]) after adjustment. No difference in death and death or NDI was noted between infants with candiduria and those with candidemia.

Conclusions: These findings provide compelling evidence that ELBW infants with candiduria are at substantial risk of death or NDI. Candiduria in ELBW preterm infants should prompt a systemic evaluation (blood, CSF, and abdominal ultrasound) for disseminated Candida infection and warrants treatment.

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Figures

Figure 1.
Figure 1.
Consort diagram of the cohort. *Groups of any infection (candidiasis or bacterial) are not mutually exclusive. Specifically, of 1515 enrolled infants, 604 had bacterial infection only, 92 infants had both Candida and bacterial infection, 45 had Candida infection only, and 774 had no proven infection. Infants with candiduria, candidemia, meningitis, or other sterile site had Candida isolated from that source alone. Abbreviations: ELBW, extremely low birth weight; NRN, neonatal research network.
See this image and copyright information in PMC

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