Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls

BMC Infectious Diseases

Susan E Richardson^1,10  Lajos Kovacs³  Chuck Hui⁵  Earl Rubin⁸  Louis de Repentigny⁶  Ben Tan⁹  Anne Synnes^1,11  Reg Sauve⁴  Nicole Le Saux⁵  Joanne M Langley²  Elizabeth Asztalos⁷  Kim Simpson^1,10  Dele H Davies⁴  Joan L Robinson^1,12  Karel O’Brien¹  Michelle Barton^1,10 

[1] Mount Sinai Hospital, University of Toronto, Ontario, Canada;Departments of Pediatrics and Community Health and Epidemiology, Dalhousie University and IWK Health Centre, Halifax, NS, Canada;Jewish General Hospital, Montreal, QC, Canada;Foothills Hospital, Calgary, AB, Canada;Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada;CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada;Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada;Montreal Children’s Hospital, Montreal, QC, Canada;Royal University Hospital, Saskatoon, SK, Canada;Division of Microbiology, Hospital for Sick Children, University of Toronto, Room 3654, Atrium, 555 University Ave, Toronto, ON M5G 1X8, Canada;Children’s & Women’s Health Centre of BC, Vancouver, BC, Canada;Stollery Children’s Hospital, Edmonton, AB, Canada

关键词: Prematurity;    Neonatal;    Risk factors;    Neurodevelopmental outcome;    Invasive candidiasis;   

Others  :  1127545
DOI  :  10.1186/1471-2334-14-327

 received in 2014-01-08, accepted in 2014-06-04,  发布年份 2014

【 摘 要 】

Background

This multicenter prospective study of invasive candidiasis (IC) was carried out to determine the risk factors for, incidence of, clinical and laboratory features, treatment and outcome of IC in infants of birth weight <1250 g.

Methods

Neonates <1250 g with IC and their matched controls (2:1) were followed longitudinally and descriptive analysis was performed. Survivors underwent neurodevelopmental assessment at 18 to 24 months corrected age. Neurodevelopmental impairment (NDI) was defined as blindness, deafness, moderate to severe cerebral palsy, or a score <70 on the Bayley Scales of Infant Development 2nd edition. Multivariable analyses were performed to determine risk factors for IC and predictors of mortality and NDI.

Results

Cumulative incidence rates of IC were 4.2%, 2.2% and 1.5% for birth-weight categories <750 g, <1000 g, <1500 g, respectively. Forty nine infants with IC and 90 controls were enrolled. Necrotizing enterocolitis (NEC) was the only independent risk factor for IC (p = 0.03). CNS candidiasis occurred in 50% of evaluated infants, while congenital candidiasis occurred in 31%. Infants with CNS candidiasis had a higher mortality rate (57%) and incidence of deafness (50%) than the overall cohort of infants with IC. NDI (56% vs. 33%; p = 0.017) and death (45% vs. 7%; p = 0.0001) were more likely in cases than in controls, respectively. IC survivors were more likely to be deaf (28% vs. 7%; p = 0.01). IC independently predicted mortality (p = 0.0004) and NDI (p = 0.018).

Conclusion

IC occurred in 1.5% of VLBW infants. Preceding NEC increased the risk of developing IC. CNS candidiasis is under-investigated and difficult to diagnose, but portends a very poor outcome. Mortality, deafness and NDI were independently significantly increased in infants with IC compared to matched controls.

【 授权许可】

   
2014 Barton et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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