Research Article

Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data

Table 4

Main candidemia finding in the NICU as reported in various studies.

Reference Main candidemia finding in the NICU

Lagrou et al., 2007 [11]Annual incidence: 0.30 episodes per 10,000 patient-days.
Sarvikivi et al., 2005 [12]Fluconazole prophylaxis contributed to the emergence of C. parapsilosis with decreased susceptibility to fluconazole.
Spiliopoulou et al., 2012 [13]Candidemia incidence decreased. C. albicans was most frequently isolated from ELBW infants. Mortality (35.7%) was associated with low gestational age and low birth weight.
Lovero et al., 2016 [14]Incidence rate of Candida non-albicans increased from 46% in 2000–2004 to 71% in 2010–2014.
Montagna et al., 2010 [15]Overall incidence: 1.3 per 100 NICU discharges. The incidence in ELBW infants was 4.3% versus 0.2% in LBW infants.
Rodriguez et al., 2006 [17]Annual incidence: 1.1 per 100 NICU discharges and 1.08 per 1000 patient-days. Low mortality (21%) rate may have been caused by a high prevalence of C. parapsilosis fungemia.
Pemán et al., 2011 [18]C. albicans was more common in the NICU setting than in the pediatric ICU.
Yalaz et al., 2006 [19]Candidemia markedly increased in 2002 compared with previous years. A significant association was found between Candida infection and the duration of antibiotic therapy.
Celebi et al., 2012 [20]Overall incidence: 11.5 per 1000 NICU admissions. The mortality rate was 42.8%.
Ozkan et al., 2014 [21]Gram-positive sepsis (67.6%) was more common than Gram-negative bacteremia (16.6%) and candidemia (15.8%). Candida spp. caused LOS (58.3%), VLOS (41,7%), and no EOS sepsis.
Clerihew et al., 2006 [22]C. parapsilosis was associated with fewer deep-seated infections than C. albicans, but mortality was similar.
Vergnano et al., 2011 [23]A decrease in candidemia was observed: 1.8% in 2006, 1.2% in 2007, and 1.3% in 2008. Candida spp. were more common in LOS (97%) than in EOS (3%) sepsis.
Aziz et al., 2010 [24]Fluconazole prophylactic administration to ELBW infants was associated with a decreased rate of candidemia.
Feja et al., 2005 [25]Overall incidence: 1.6 per 100 NICU discharges. Catheter use, previous bacterial sepsis, and GI pathology were significantly associated with candidemia.
Bizzarro et al., 2015 [28]Candida spp. were more common in LOS than in EOS sepsis.
Natarajan et al., 2009 [29]Candidemia refractory to conventional antifungals was associated with prolonged antibiotic use and Candida non-albicans infection.
Robinson et al., 2012 [30]Overall incidence: 0.45 per 100 NICU discharges. An increased time between blood culture draw and initial antifungal therapy was associated with an increased incidence of persistent candidemia.
Batista et al., 2014 [31]Oral colonization should be considered as a risk factor for candidemia.
Hua et al., 2012 [35]Patients with C. parapsilosis had a significantly longer hospital stay than those with C. albicans sepsis.
Wu et al., 2014 [36]C. guilliermondii was associated with preterm infants and with low birth weight.
Chen et al., 2015 [37]Fluconazole prophylaxis alone was not efficacious; it had to be combined with reinforcement of management and supervision of hand hygiene to effectively prevent invasive candidiasis.
Rani et al., 2002 [38]Candida non-albicans accounted for 96% of the cases of neonatal candidemia.
Agarwal et al., 2004 [39]Overall incidence: 77 per 1000 NICU discharges. Candida non-albicans is gaining importance as a cause of neonatal septicemia.
Femitha et al., 2013 [40]Overall incidence: 0.82 cases per 100 NICU discharges. Mortality was 44.4%. Presence of candiduria was a significant riskfactor for death.
Mehara et al., 2013 [41]Candida spp. were more common in LOS than in EOS sepsis.
Juyal et al., 2013 [42]Candida non-albicans accounted for 80.30% of the cases of neonatal candidemia. The crude mortality was 34.85%.
Chaurasia et al., 2015 [43]Clinical features in neonates with candida sepsis were nonspecific. A common laboratory feature was thrombocytopenia.
Al-Sweih et al., 2009 [45]Overall incidence: 4 per 100 NICU discharges.
Hammoud et al., 2013 [46]C. albicans was the most prevalent species in nonpersistent candidemia. C. parapsilosis was more common among infants with persistent candidemia. Persistent candidemia was associated with an increased risk of mortality.
Wu et al., 2009 [48]The most common causative microorganisms of LOS sepsis were CONS and Candida spp. C. parapsilosis was associated with a high mortality rate.
Tsai et al., 2014 [49]Candidemia had a significantly higher rate of infectious complications, persistent bloodstream infection, and sepsis-attributable mortality than Gram-negative and Gram-positive bacteremia.
Lim et al., 2012 [50]Sepsis by Gram-negative bacteria or Candida spp. presented with more severe clinical symptoms and was associated with a higher mortality rate compared with that by Gram-positive bacteria.
Chen et al., 2015 [37] Decrease incidence of candidemia during the study period.
Ballot et al., 2013 [51]Increased incidence of Candida non-albicans during the study period.

CONS: coagulase-negative staphylococci; ELBW: extremely low birth weight; VLBW: very low birth weight; GI: gastrointestinal; EOS: early-onset sepsis; LOS: late-onset sepsis; VLOS: very late-onset sepsis; NICU: neonatal intensive care unit; ICU: intensive care unit.