Neonatal Candidiasis: Epidemiology, Risk Factors, and Clinical Judgment

被引：263

作者：

Benjamin, Daniel K., Jr.

Stoll, Barbara J. ^{[1
]}

Gantz, Marie G. ^{[2
]}

Walsh, Michele C. ^{[3
]}

Sanchez, Pablo J. ^{[4
]}

Das, Abhik ^{[5
]}

Shankaran, Seetha ^{[6
]}

Higgins, Rosemary D. ^{[7
]}

Auten, Kathy J. ^{[23
]}

Miller, Nancy A. ^{[4
]}

Walsh, Thomas J. ^{[8
]}

Laptook, Abbot R. ^{[9
]}

Carlo, Waldemar A. ^{[10
]}

Kennedy, Kathleen A. ^{[11
]}

Finer, Neil N. ^{[12
]}

Duara, Shahnaz ^{[13
]}

Schibler, Kurt ^{[14
]}

Chapman, Rachel L. ^{[15
]}

Van Meurs, Krisa P. ^{[16
]}

Frantz, Ivan D., III ^{[17
]}

Phelps, Dale L. ^{[18
]}

Poindexter, Brenda B. ^{[19
]}

Bell, Edward F. ^{[20
]}

O'Shea, T. Michael ^{[21
]}

Watterberg, Kristi L. ^{[22
]}

Goldberg, Ronald N. ^{[23
]}

机构：

[1] Emory Univ & Childrens Healthcare Atlanta, Dept Pediat, Atlanta, GA USA

[2] RTI Int, Statist Epidemiol Unit, Res Triangle Pk, NC USA

[3] Case Western Reserve Univ, Dept Pediat, Rainbow Babies & Childrens Hosp, Cleveland, OH 44106 USA

[4] Univ Texas Dallas, Dept Pediat, SW Med Ctr, Dallas, TX 75230 USA

[5] RTI Int, Statist & Epidemiol Unit, Rockville, MD USA

[6] Wayne State Univ, Dept Pediat, Detroit, MI 48202 USA

[7] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Bethesda, MD USA

[8] Human Dev & Natl Canc Inst, Natl Inst Hlth, Bethesda, MD USA

[9] Brown Univ, Dept Pediat, Women & Infants Hosp, Providence, RI 02912 USA

[10] Univ Alabama Birmingham, Dept Pediat, Birmingham, AL USA

[11] Univ Texas Houston, Sch Med, Dept Pediat, Houston, TX USA

[12] Univ Calif San Diego, Dept Pediat, San Diego, CA 92103 USA

[13] Univ Miami, Miller Sch Med, Miami, FL 33136 USA

[14] Cincinnati Childrens Hosp, Med Ctr, Dept Pediat, Cincinnati, OH USA

[15] Yale Univ, Sch Med, Dept Pediat, New Haven, CT 06510 USA

[16] Stanford Univ, Sch Med, Dept Pediat, Palo Alto, CA 94304 USA

[17] Tufts Med Ctr, Boston, MA USA

[18] Univ Rochester, Sch Med & Dent, Rochester, NY USA

[19] Indiana Univ, Sch Med, Dept Pediat, Indianapolis, IN 46202 USA

[20] Univ Iowa, Iowa City, IA USA

[21] Wake Forest Univ, Winston Salem, NC 27109 USA

[22] Univ New Mexico, Hlth Sci Ctr, Albuquerque, NM 87131 USA

[23] Duke Univ, Dept Pediat, Durham, NC 27706 USA

来源：

PEDIATRICS | 2010年 / 126卷 / 04期

基金：

美国国家卫生研究院;

关键词：

candidiasis; premature infant; risk factors; BIRTH-WEIGHT INFANTS; FLUCONAZOLE PROPHYLAXIS; INVASIVE CANDIDIASIS; FUNGAL COLONIZATION; CANDIDEMIA; INFECTION; SUSCEPTIBILITY; MULTICENTER; THERAPY;

D O I：

10.1542/peds.2009-3412

中图分类号：

R72 [儿科学];

学科分类号：

100202 [儿科学];

摘要：

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, broad-spectrum 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. Pediatrics 2010;126:e865-e873

引用

页码：E865 / E873

页数：9

共 24 条

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