Journal article
Neonatal Candidiasis: Epidemiology, Risk Factors, and Clinical Judgment
Pediatrics (Evanston), Vol.126(4), pp.e865-e873
10/2010
DOI: 10.1542/peds.2009-3412
PMCID: PMC3045840
PMID: 20876174
Abstract
OBJECTIVE: Invasive candidiasis is a leading cause of infection-related morbidity and mortality in extremely low birth weight (<1000-g) infants. We quantified risk factors that predict infection in premature infants at high risk and compared clinical judgment with a prediction model of invasive candidiasis.
METHODS: The study involved a prospective observational cohort of infants ≤1000 g birth weight at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. At each sepsis evaluation, clinical information was recorded, cultures were obtained, and clinicians prospectively recorded their estimate of the probability of invasive candidiasis. Two models were generated with invasive candidiasis as their outcome: (1) potentially modifiable risk factors; and (2) a clinical model at time of blood culture to predict candidiasis.
RESULTS: Invasive candidiasis occurred in 137 of 1515 (9.0%) infants and was documented by positive culture from ≥1 of these sources: blood (n = 96); cerebrospinal fluid (n = 9); urine obtained by catheterization (n = 52); or other sterile body fluid (n = 10). Mortality rate was not different for infants who had positive blood culture compared with those with isolated positive urine culture. Incidence of candida varied from 2% to 28% at the 13 centers that enrolled ≥50 infants. Potentially modifiable risk factors included central catheter, broad-spectrum antibiotics (eg, third-generation cephalosporins), intravenous lipid emulsion, endotracheal tube, and antenatal antibiotics. The clinical prediction model had an area under the receiver operating characteristic curve of 0.79 and was superior to clinician judgment (0.70) in predicting subsequent invasive candidiasis.
CONCLUSION: Previous antibiotics, presence of a central catheter or endotracheal tube, and center were strongly associated with invasive candidiasis. Modeling was more accurate in predicting invasive candidiasis than clinical judgment.
Details
- Title: Subtitle
- Neonatal Candidiasis: Epidemiology, Risk Factors, and Clinical Judgment
- Creators
- Daniel K Benjamin - Department of Pediatrics, Duke University, Durham, North CarolinaBarbara J Stoll - Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, GeorgiaMarie G Gantz - Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North CarolinaMichele C Walsh - Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OhioPablo J Sanchez - Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TexasAbhik Das - Statistics and Epidemiology Unit, RTI International, Rockville, MarylandSeetha Shankaran - Department of Pediatrics, Wayne State University, Detroit, MichiganRosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MarylandKathy J Auten - Department of Pediatrics, Duke University, Durham, North CarolinaNancy A Miller - Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TexasThomas J Walsh - National Cancer Institute, National Institutes of Health, Bethesda, MarylandAbbot R Laptook - Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode IslandWaldemar A Carlo - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AlabamaKathleen A Kennedy - Department of Pediatrics, University of Texas Medical School at Houston, Houston, TexasNeil N Finer - Department of Pediatrics, University of California, San Diego, CaliforniaShahnaz Duara - University of Miami Miller School of Medicine, Miami, FloridaKurt Schibler - Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OhioRachel L Chapman - Department of Pediatrics, Yale University School of Medicine, New Haven, ConnecticutKrisa P Van Meurs - Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CaliforniaIvan D Frantz - Tufts Medical Center, Boston, MassachusettsDale L Phelps - University of Rochester School of Medicine and Dentistry, Rochester, New YorkBrenda B Poindexter - Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IndianaEdward F Bell - University of Iowa, Iowa City, IowaT. Michael O’Shea - Wake Forest University, Winston-Salem, North CarolinaKristi L Watterberg - University of New Mexico Health Science Center, Albuquerque, New MexicoRonald N Goldberg - Department of Pediatrics, Duke University, Durham, North CarolinaEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- Pediatrics (Evanston), Vol.126(4), pp.e865-e873
- DOI
- 10.1542/peds.2009-3412
- PMID
- 20876174
- PMCID
- PMC3045840
- NLM abbreviation
- Pediatrics
- ISSN
- 0031-4005
- eISSN
- 1098-4275
- Publisher
- American Academy of Pediatrics
- Language
- English
- Date published
- 10/2010
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984093607902771
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