Risk factors for invasive candidiasis in infants clarified

Feb 19 2013

By Helen Albert, Senior medwireNews Reporter

A combination of exposure to broad-spectrum antibiotics and having a platelet count below 50,000/mm³ significantly increases a low-to-normal-weight infant's chance for developing invasive candidiasis, report researchers.

Babies with an extremely low birthweight (<1000 g) are known to have the highest risk for invasive candidiasis, a causative factor for late-onset sepsis in the neonatal intensive care unit (NICU), but factors increasing the risk for this infection in infants with a heavier birthweight (>1500 g) are less clear.

Daniel Benjamin (Duke University Medical Center, Durham, North Carolina, USA) and colleagues carried out a retrospective cohort study of 530,162 infants with a birthweight over 1500 g who were discharged from Pediatrix Medical Group NICUs between 2001 and 2010.

Invasive candidiasis is rare in infants with a birthweight above 1500 g. In total, 330 infants in the cohort had invasive candidiasis (0.06%), as compared with a cumulative incidence of 7% in infants with a birthweight below 1000 g noted in previous studies. Infants sigh invasive candidiasis had a 2.2-fold increased mortality rate compared with others in the cohort and had significantly longer mean hospital stays (61 vs 12 days).

Risk factors for developing invasive candidiasis included being older than 7 days (odds ratio [OR]=25.2), being born vaginally (OR=1.6), exposure to broad-spectrum antibiotics (OR=1.6), having a central venous line (OR=2.3), and having a platelet count below 50,000/mm³ (OR=3.7).

In general, the risk factors had poor sensitivities and low positive and negative likelihood ratios. A combination of exposure to broad-spectrum antibiotics and a low platelet count had the highest positive likelihood ratio, at 46.2, but this only had a sensitivity of 4%.

"Although we identified several risk factors for invasive candidiasis, these risk factors are not sufficiently robust to identify populations that will be feasible for the conduct of definitive trials," write Benjamin and team in The Pediatric Infectious Disease Journal.

"Given the low incidence of invasive candidiasis, we did not identify a population in which prophylaxis would be indicated. The decision to start empirical antifungal therapy should occur after examining risk factors in the infant in the context of the baseline incidence of invasive candidiasis for that particular NICU."

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