Neonatal candidiasis: Epidemiology, risk factors, and clinical judgment

Daniel K. Benjamin, Barbara J. Stoll, Marie G. Gantz, Michele C. Walsh, Pablo J. Sánchez, Abhik Das, Seetha Shankaran, Rosemary D. Higgins, Kathy J. Auten, Nancy A. Miller, Thomas J. Walsh, Abbot R. Laptook, Waldemar A. Carlo, Kathleen A. Kennedy, Neil N. Finer, Shahnaz Duara, Kurt Schibler, Rachel L. Chapman, Krisa P. Van Meurs, Ivan D. FrantzDale L. Phelps, Brenda B. Poindexter, Edward F. Bell, T. Michael O'Shea, Kristi L. Watterberg, Ronald N. Goldberg

Research output: Contribution to journalArticle

183 Citations (Scopus)

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, broadspectrum 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.

Original languageEnglish
JournalPediatrics
Volume126
Issue number4
DOIs
StatePublished - Oct 2010

Fingerprint

Invasive Candidiasis
Candidiasis
Epidemiology
Anti-Bacterial Agents
Catheters
Intravenous Fat Emulsions
National Institute of Child Health and Human Development (U.S.)
Urine
Mortality
Low Birth Weight Infant
Body Fluids
Cephalosporins
Infection
Candida
Birth Weight
Premature Infants
ROC Curve
Catheterization
Cerebrospinal Fluid
Sepsis

Keywords

  • Candidiasis
  • Premature infant
  • Risk factors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Benjamin, D. K., Stoll, B. J., Gantz, M. G., Walsh, M. C., Sánchez, P. J., Das, A., ... Goldberg, R. N. (2010). Neonatal candidiasis: Epidemiology, risk factors, and clinical judgment. Pediatrics, 126(4). https://doi.org/10.1542/peds.2009-3412

Neonatal candidiasis : Epidemiology, risk factors, and clinical judgment. / Benjamin, Daniel K.; Stoll, Barbara J.; Gantz, Marie G.; Walsh, Michele C.; Sánchez, Pablo J.; Das, Abhik; Shankaran, Seetha; Higgins, Rosemary D.; Auten, Kathy J.; Miller, Nancy A.; Walsh, Thomas J.; Laptook, Abbot R.; Carlo, Waldemar A.; Kennedy, Kathleen A.; Finer, Neil N.; Duara, Shahnaz; Schibler, Kurt; Chapman, Rachel L.; Van Meurs, Krisa P.; Frantz, Ivan D.; Phelps, Dale L.; Poindexter, Brenda B.; Bell, Edward F.; O'Shea, T. Michael; Watterberg, Kristi L.; Goldberg, Ronald N.

In: Pediatrics, Vol. 126, No. 4, 10.2010.

Research output: Contribution to journalArticle

Benjamin, DK, Stoll, BJ, Gantz, MG, Walsh, MC, Sánchez, PJ, Das, A, Shankaran, S, Higgins, RD, Auten, KJ, Miller, NA, Walsh, TJ, Laptook, AR, Carlo, WA, Kennedy, KA, Finer, NN, Duara, S, Schibler, K, Chapman, RL, Van Meurs, KP, Frantz, ID, Phelps, DL, Poindexter, BB, Bell, EF, O'Shea, TM, Watterberg, KL & Goldberg, RN 2010, 'Neonatal candidiasis: Epidemiology, risk factors, and clinical judgment', Pediatrics, vol. 126, no. 4. https://doi.org/10.1542/peds.2009-3412
Benjamin DK, Stoll BJ, Gantz MG, Walsh MC, Sánchez PJ, Das A et al. Neonatal candidiasis: Epidemiology, risk factors, and clinical judgment. Pediatrics. 2010 Oct;126(4). https://doi.org/10.1542/peds.2009-3412
Benjamin, Daniel K. ; Stoll, Barbara J. ; Gantz, Marie G. ; Walsh, Michele C. ; Sánchez, Pablo J. ; Das, Abhik ; Shankaran, Seetha ; Higgins, Rosemary D. ; Auten, Kathy J. ; Miller, Nancy A. ; Walsh, Thomas J. ; Laptook, Abbot R. ; Carlo, Waldemar A. ; Kennedy, Kathleen A. ; Finer, Neil N. ; Duara, Shahnaz ; Schibler, Kurt ; Chapman, Rachel L. ; Van Meurs, Krisa P. ; Frantz, Ivan D. ; Phelps, Dale L. ; Poindexter, Brenda B. ; Bell, Edward F. ; O'Shea, T. Michael ; Watterberg, Kristi L. ; Goldberg, Ronald N. / Neonatal candidiasis : Epidemiology, risk factors, and clinical judgment. In: Pediatrics. 2010 ; Vol. 126, No. 4.
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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, broadspectrum 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.",
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T2 - Epidemiology, risk factors, and clinical judgment

AU - Benjamin, Daniel K.

AU - Stoll, Barbara J.

AU - Gantz, Marie G.

AU - Walsh, Michele C.

AU - Sánchez, Pablo J.

AU - Das, Abhik

AU - Shankaran, Seetha

AU - Higgins, Rosemary D.

AU - Auten, Kathy J.

AU - Miller, Nancy A.

AU - Walsh, Thomas J.

AU - Laptook, Abbot R.

AU - Carlo, Waldemar A.

AU - Kennedy, Kathleen A.

AU - Finer, Neil N.

AU - Duara, Shahnaz

AU - Schibler, Kurt

AU - Chapman, Rachel L.

AU - Van Meurs, Krisa P.

AU - Frantz, Ivan D.

AU - Phelps, Dale L.

AU - Poindexter, Brenda B.

AU - Bell, Edward F.

AU - O'Shea, T. Michael

AU - Watterberg, Kristi L.

AU - Goldberg, Ronald N.

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N2 - 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, broadspectrum 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.

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