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Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases
Abstract
OBJECTIVE: To determine changes in the incidence of candidemia in a neonatal intensive care unit (NICU) during a 15-year period (1981 to 1995) and to compare the prevalence and case fatality rates of Candida albicans and Candida parapsilosis infections. METHODS: A retrospective study was conducted of candidemia occurring in infants in a NICU between January 1, 1981, and December 31, 1995. Cases were identified through computerized searching of a microbiology blood culture database. Candidemia was considered contributory to mortality if death occurred within 3 days of positive blood cultures or if there was autopsy evidence of disseminated candidiasis. RESULTS: One hundred eleven cases of candidemia occurred in 107 infants, representing 1% of all NICU patients during the study period. The rate of candidemia in the NICU increased from 2.5 cases per 1000 admissions in 1981 to 1985, to 4.6 per 1000 admissions in 1986 to 1990 and to 28.5 per 1000 in 1991 to 1995 (P = 0.001). C. albicans was the predominant cause of candidemia between 1981 and 1990. C. parapsilosis was the most prevalent species between 1991 and 1995, causing 53 of 89 cases (60%). The mortality from C. albicans, 13 of 50 cases (26%), was significantly higher than the mortality from C. parapsilosis, 2 of 54 (4%) (P = 0.002; relative risk, 7; 95% confidence interval, 1.7 to 30). CONCLUSIONS: The rate of candidemia in our neonatal intensive care unit increased >11-fold in the 15 years from 1981 to 1995; the prevalent Candida species shifted from C. albicans to C. parapsilosis; and candidemia associated with C. albicans has significantly higher mortality than with C. parapsilosis.
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“Candidemia due to C. parapsilosis has increased in frequency in pediatric populations and appears to be associated with a lower mortality rate than is candidemia due to other species of Candida [110-113].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [111]
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Stoll, B. J., Gordon, T., Korones, S. B., Shankaran, S., Tyson, J. E., Bauer, C. R., Fanaroff, A. A., Lemons, J. A., Donovan, E. F., Oh, W., et al. (1996) · The Journal of Pediatrics · doi:10.1016/s0022-3476(96)70191-9 · Cited by 871
Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality.
Fraser, V. J., Jones, M., Dunkel, J., Storfer, S., Medoff, G., & Dunagan, W. C. (1992) · Clinical Infectious Diseases · doi:10.1093/clind/15.3.414 · Cited by 679
Weems, J. J. (1992) · Clinical Infectious Diseases · doi:10.1093/clinids/14.3.756 · Cited by 399
Fungal Colonization in the Very Low Birth Weight Infant
Baley, J. E., Kliegman, R. M., Boxerbaum, B., & Fanaroft, A. A. (1986) · PEDIATRICS · doi:10.1542/peds.78.2.225 · Cited by 227
High frequency of yeast carriage on hands of hospital personnel
Strausbaugh, L. J., Sewell, D. L., Ward, T. T., Pfaller, M. A., Heitzman, T., & Tjoelker, R. (1994) · Journal of Clinical Microbiology · doi:10.1128/jcm.32.9.2299-2300.1994 · Cited by 188
Horbar, J. D., Wright, E. C., & Onstad, L. (1993) · PubMed · Cited by 186
Vertical and Horizontal Transmission of Unique Candida Species to Premature Newborns
Waggoner-Fountain, L. A., Walker, M. W., Hollis, R. J., Pfaller, M. A., Ferguson, J. E., II, Wenzel, R. P., & Donowitz, L. G. (1996) · Clinical Infectious Diseases · doi:10.1093/clinids/22.5.803 · Cited by 172
Candida: An Increasingly Important Pathogen in the Nursery
BUTLER, K. M., & Baker, C. J. (1988) · Pediatric Clinics of North America · doi:10.1016/s0031-3955(16)36471-9 · Cited by 172
Horbar, J. D., Wright, E. C., & Onstad, L. (1993) · PEDIATRICS · doi:10.1542/peds.92.2.191 · Cited by 162
Candidemia in a Pediatric Population
Stamos, J. K., & Rowley, A. H. (1995) · Clinical Infectious Diseases · doi:10.1093/clinids/20.3.571 · Cited by 159
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Guidelines for Treatment of Candidiasis
Pappas, P. G., Rex, J. H., Sobel, J. D., Filler, S. G., Dismukes, W. E., Walsh, T. J., & Edwards, J. E. (2004) · Clinical Infectious Diseases · doi:10.1086/380796 · Cited by 1,440
Silva, S., Negri, M., Henriques, M., Oliveira, R., Williams, D. W., & Azeredo, J. (2012) · FEMS Microbiology Reviews · doi:10.1111/j.1574-6976.2011.00278.x · Cited by 969
Practice Guidelines for the Treatment of Candidiasis
Rex, J. H., Walsh, T. J., Sobel, J. D., Filler, S. G., Pappas, P. G., Dismukes, W. E., & Edwards, J. E. (2000) · Clinical Infectious Diseases · doi:10.1086/313749 · Cited by 927
Epidemiology of Candida species infections in critically ill non-immunosuppressed patients
Eggimann, P., Garbino, J., & Pittet, D. (2003) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(03)00801-6 · Cited by 900
Nosocomial fungal infections: epidemiology, diagnosis, and treatment
Perlroth, J., Choi, B., & Spellberg, B. (2007) · Medical Mycology · doi:10.1080/13693780701218689 · Cited by 738
Metadata
- Authors
- KOSSOFF, E. H., BUESCHER, E. S., & KARLOWICZ, M. G.
- Affiliations
- Eastern Virginia Medical School (US)
- ORCID
- KOSSOFF, ERIC H.
- Venue
- The Pediatric Infectious Disease Journal
- Published
- 1998-06
- Volume
- 17
- Issue
- 6
- Pages
- 504-508
- ISSN
- 0891-3668 (ISSN-L)
- OpenAlex
- W1985021288
- Cited by
- 330
- References
- 27
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 7 · 2022: 3 · 2021: 3 · 2020: 9 · 2019: 5 · 2018: 6 · 2017: 6 · 2016: 6 · 2015: 9 · 2014: 9 · 2013: 13 · 2012: 15
- FWCI
- 11.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Pediatric Infectious Disease Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and Maternal Infections
- Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
- Keywords
- candidemia, neonatal intensive care unit, Candida albicans, Candida parapsilosis, incidence trends, case fatality rate, neonatal mortality, systemic candidiasis, fungemia, infants
- MeSH terms
- Candida albicans, Candidiasis, Humans, Infant Mortality, Infant, Low Birth Weight, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Intensive Care Units, Neonatal, Retrospective Studies, Incidence, Prevalence, Fungemia, Statistics, Nonparametric
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- KOSSOFF, E. H., BUESCHER, E. S., & KARLOWICZ, M. G. (1998). Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases. The Pediatric Infectious Disease Journal. https://doi.org/10.1097/00006454-199806000-00014
