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

Research Article

Louis de Repentigny¹  Anne Synnes²  Nicole Le Saux³  Chuck Hui⁴  Joanne M Langley⁵  Kim Simpson⁶  Susan E Richardson⁶  Michelle Barton⁶  Reg Sauve⁷  Dele H Davies⁷  Lajos Kovacs⁸  Earl Rubin⁹  Karel O’Brien^1,10  Ben Tan^1,11  Joan L Robinson^1,12  Elizabeth Asztalos^1,13 

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

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

DOI  :  10.1186/1471-2334-14-327

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

来源: Springer

【 摘 要 】

BackgroundThis 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.MethodsNeonates <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.ResultsCumulative 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).ConclusionIC 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】

Unknown   
© Barton et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.