Epidemiology and risk factors for Candida infection in neonates
- Mohan Pammi, MD, PhD
Mohan Pammi, MD, PhD
- Associate Professor
- Baylor College of Medicine
- Section Editors
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Infections due to Candida are one of the major causes of mortality and morbidity in preterm infants, especially in extremely low and very low birth weight infants [1-4].
The epidemiology and risk factors for neonatal candidal infections will be reviewed here. Clinical manifestations, prevention, and treatment of neonatal candidal infections are presented separately. (See "Clinical manifestations and diagnosis of Candida infection in neonates" and "Prevention of Candida infection in neonates" and "Treatment of Candida infection in neonates".)
Candida species are important hospital-acquired pathogens in infants admitted to the neonatal intensive care unit (NICU). In very low birth weight (VLBW) infants (birth weight less than 1500 g), Candida albicans is the third most common cause of neonatal late onset sepsis (LOS), which occurs after the first 72 hours of life. This was illustrated in a multicenter study from the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network that evaluated 6956 VLBW infants (range of birth weight from 401 to 1500 g) admitted over a two-year period from 1998 to 2000 . C. albicans was the causative agent in 6 percent of first episodes of LOS following Coagulase negative Staphylococcus (48 percent) and Staphylococcus aureus (8 percent) in frequency . In addition, Candida parapsilosis was isolated as the causative agent in 4 percent of the cases.
The incidence of Candida infections is greatest in extremely low birth weight (ELBW) infants (ie, birth weights <1000 g), as demonstrated by a study from the National Nosocomial Infections Surveillance (NNIS) system that included 130,523 patients admitted to 128 NICUs between 1995 and 2004 . The overall incidence of Candida blood stream infections was 1.53 per 1000 patient-days among the infants admitted to the NICU. The annual incidences varied based upon birth weight as follows:
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