Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 717-722 (doi:10.1542/peds.2005-2677)
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Candidiasis (Moniliasis, Thrush)

ARTICLE

The Association of Third-Generation Cephalosporin Use and Invasive Candidiasis in Extremely Low Birth-Weight Infants

C. Michael Cotten, MDa, Scott McDonaldb, Barbara Stoll, MDc, Ronald N. Goldberg, MDa, Kenneth Poole, PhDb, Daniel K. Benjamin, Jr, MD, MPH, PhDa,d on behalf of the National Institute for Child Health and Human Development Neonatal Research Network

a Duke University Department of Pediatrics, Durham, North Carolina
b RTI International, Research Triangle Park, North Carolina
c Emory University Department of Pediatrics, Atlanta, Georgia
d Duke Clinical Research Institute, Durham, North Carolina

OBJECTIVES. Previous studies have shown that incidence of invasive candidiasis varies substantially among centers, and previous use of broad-spectrum antibiotics is a risk factor for candidiasis in extremely low birth-weight infants. Differences in center practices, such as antibiotic strategies and the effects of these strategies on center incidence of candidiasis, are not reflected in assessments of an individual's risk of candidiasis. We evaluated the relationship between empirical antibiotic practices for extremely low birth-weight infants and center incidence of candidiasis.

METHODS. We studied a cohort of extremely low birth-weight infants who survived ≥72 hours and were admitted to 1 of 12 tertiary centers between 1998 and 2001. Multivariable logistic regression was used to validate previous broad-spectrum antibiotics use as a risk factor for subsequent candidiasis in individual infants. We calculated correlation coefficients to assess the relationship between center incidence of candidiasis with antibiotic practice patterns.

RESULTS. There were 3702 infants from 12 centers included, and 284 (7.7%) developed invasive candidiasis. Broad-spectrum antibiotics use was associated with candidiasis for individual infants. Center candidiasis incidence ranged from 2.4% to 20.4%. Center incidence of candidiasis was correlated with average broad-spectrum antibiotics use per infant and average use of broad-spectrum antibiotics with negative cultures per infant.

CONCLUSIONS. Center incidences of invasive candidiasis differ substantially, and antibiotic practice differences are possible contributors to center variation in candidiasis risk.

Key Words: antibiotic use • bloodstream infection • candida • candidemia • LBW • extremely low birth weight

Abbreviations: ELBW—extremely low birth weight • BSA—broad-spectrum antibiotic • NEC—necrotizing enterocolitis • CC—correlation coefficient

Accepted Mar 20, 2006.




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