PEDIATRICS Vol. 106 No. 4 October 2000, pp. 712-718
When to Suspect Fungal Infection in Neonates: A Clinical Comparison of Candida albicans and Candida parapsilosis Fungemia With Coagulase-Negative Staphylococcal Bacteremia
Received Aug 3, 1999; accepted Feb 24, 2000.
,
From the * Department of Pediatrics, Duke University, Medical
Center, Durham, North Carolina; and the Department of Economics,
Clemson University, Clemson, South Carolina.
Objectives. To determine the epidemiology of candidemia in our neonatal intensive care unit; to compare risk factors, clinical presentation, and outcomes for neonates infected with Candida albicans, Candida parapsilosis, and coagulase-negative staphylococcus (CoNS); and to suggest a rational approach to empiric antifungal therapy of neonates at risk for nosocomial infection.
Design. Retrospective chart review of all neonatal intensive care unit patients with systemic candidiasis or CoNS infection between January 1, 1995 and July 31, 1998 at Duke University Medical Center.
Results. Fifty-one patients were reviewed. Nine of 19 patients infected with C parapsilosis and 5 of 15 patients infected with C albicans died of fungemia. Seventeen neonates had >2 positive cultures for CoNS obtained within 96 hours and 1 died. There was no statistically significant difference in birth weight, gestational age, or age at diagnosis between patient groups; however, candidemic patients had a sevenfold higher mortality rate. Before diagnosis, candidemic patients had greater exposure to systemic steroids, antibiotics, and catecholamine infusions. Of the 51 patients, 32 received third-generation cephalosporins in the 2 weeks before diagnosis and 19 did not. Twenty-nine of the 32 who were treated with third-generation cephalosporins subsequently developed candidemia, while candidemia occurred in only 5 of 19 patients who were not treated with cephalosporins. At the time of diagnosis, candidemic patients were more likely to have required mechanical ventilation and were less likely to be tolerating enteral feeding. Multivariate clustered logistic regression analysis revealed that candidemic patients had more exposure to third-generation cephalosporins. Once the clinician was notified of a positive blood culture for Candida, patients infected with C parapsilosis retained their central catheters longer than patients infected with C albicans.
Conclusions. In this retrospective review, we were able to identify aspects of the clinical presentation and medication history that may be helpful in differentiating between candidemia and CoNS bacteremia. Those key features may be used by clinicians to initiate empiric amphotericin B therapy in premature neonates at risk for nosocomial infections. Prolonged use of third-generation cephalosporins was strongly associated with candidemia. There was no statistically significant difference in the morbidity and mortality between patients infected with C parapsilosis and those infected with C albicans. Observed delays in removal of the central venous catheter may have contributed to finding a mortality rate from C parapsilosis that was higher than was previously reported. Key words: Candida, parapsilosis, albicans, Staphylococcus epidermidis, neonate, sepsis, platelets, amphotericin, central line, cephalosporin.
This article has been cited by other articles:
 |
|
 |
|
  M Brecht, L Clerihew, and W McGuire Prevention and treatment of invasive fungal infection in very low birthweight infants Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2009; 94(1): F65 - F69. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Petraitiene, V. Petraitis, W. W. Hope, D. Mickiene, A. M. Kelaher, H. A. Murray, C. Mya-San, J. E. Hughes, M. P. Cotton, J. Bacher, et al. Cerebrospinal Fluid and Plasma (1->3)-{beta}-D-Glucan as Surrogate Markers for Detection and Monitoring of Therapeutic Response in Experimental Hematogenous Candida Meningoencephalitis Antimicrob. Agents Chemother., November 1, 2008; 52(11): 4121 - 4129. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Trofa, A. Gacser, and J. D. Nosanchuk Candida parapsilosis, an Emerging Fungal Pathogen Clin. Microbiol. Rev., October 1, 2008; 21(4): 606 - 625. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A McCrossan, E. McHenry, F. O'Neill, G. Ong, and D. G Sweet Selective fluconazole prophylaxis in high-risk babies to reduce invasive fungal infection Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2007; 92(6): F454 - F458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L Clerihew, T L Lamagni, P Brocklehurst, and W McGuire Candida parapsilosis infection in very low birthweight infants Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2007; 92(2): F127 - F129. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Cotten, S. McDonald, B. Stoll, R. N. Goldberg, K. Poole, D. K. Benjamin Jr, and on behalf of the National Institute for Child Heal The Association of Third-Generation Cephalosporin Use and Invasive Candidiasis in Extremely Low Birth-Weight Infants Pediatrics, August 1, 2006; 118(2): 717 - 722. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L Clerihew, T L Lamagni, P Brocklehurst, and W McGuire Invasive fungal infection in very low birthweight infants: national prospective surveillance study Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2006; 91(3): F188 - F192. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Cocuaud, M.-H. Rodier, G. Daniault, and C. Imbert Anti-metabolic activity of caspofungin against Candida albicans and Candida parapsilosis biofilms J. Antimicrob. Chemother., September 1, 2005; 56(3): 507 - 512. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Kaufman and K. D. Fairchild Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants Clin. Microbiol. Rev., July 1, 2004; 17(3): 638 - 680. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. Benjamin Jr, E. R. DeLong, W. J. Steinbach, C. M. Cotton, T. J. Walsh, and R. H. Clark Empirical Therapy for Neonatal Candidemia in Very Low Birth Weight Infants Pediatrics, September 1, 2003; 112(3): 543 - 547. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. Benjamin Jr, C. Poole, W. J. Steinbach, J. L. Rowen, and T. J. Walsh Neonatal Candidemia and End-Organ Damage: A Critical Appraisal of the Literature Using Meta-analytic Techniques Pediatrics, September 1, 2003; 112(3): 634 - 640. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Guida, A. M. Kunig, K. H. Leef, S. E. McKenzie, and D. A. Paul Platelet Count and Sepsis in Very Low Birth Weight Neonates: Is There an Organism-Specific Response? Pediatrics, June 1, 2003; 111(6): 1411 - 1415. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Onyewu, J. R. Blankenship, M. Del Poeta, and J. Heitman Ergosterol Biosynthesis Inhibitors Become Fungicidal when Combined with Calcineurin Inhibitors against Candida albicans, Candida glabrata, and Candida krusei Antimicrob. Agents Chemother., March 1, 2003; 47(3): 956 - 964. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. Benjamin Jr, W. Miller, H. Garges, D. K. Benjamin, R. E. McKinney Jr, M. Cotton, R. G. Fisher, and K. A. Alexander Bacteremia, Central Catheters, and Neonates: When to Pull the Line Pediatrics, June 1, 2001; 107(6): 1272 - 1276. [Abstract] [Full Text] [PDF]
|
|
