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Risk Factors for Invasive Candidiasis in Infants >1500 g Birth Weight


Lee, Jan Hau; Hornik, Christoph P.; Benjamin, Daniel K., Jr.; Herring, Amy H.; Clark, Reese H.; Cohen-Wolkowiez, Michael; & Smith, P. Brian (2013). Risk Factors for Invasive Candidiasis in Infants >1500 g Birth Weight. Pediatric Infectious Disease Journal, 32(3), 222-226. PMCID: PMC3578110


BACKGROUND: We describe the incidence, risk factors, and outcomes of invasive candidiasis in infants >1500 g birth weight.
METHODS: We conducted a retrospective cohort study of infants >1500 g birth weight discharged from 305 NICUs in the Pediatrix Medical Group from 2001-2010. Using multivariable logistic regression, we identified risk factors for invasive candidiasis.
RESULTS: Invasive candidiasis occurred in 330/530,162 (0.06%) infants. These were documented from positive cultures from >/=1 of these sources: blood (n=323), cerebrospinal fluid (n=6), or urine from catheterization (n=19). Risk factors included day of life >7 (OR 25.2; 95% CI 14.6-43.3), vaginal birth (OR 1.6 [1.2-2.3]), exposure to broad-spectrum antibiotics (OR 1.6 [1.1-2.4]), central venous line (OR 1.8 [1.3-2.6]), and platelet count <50,000/mm (OR 3.7 [2.1-6.7]). All risk factors had poor sensitivities, low positive likelihood ratios, and low positive predictive values. The combination of broad-spectrum antibiotics and low platelet count had the highest positive likelihood ratio (46.2), but the sensitivity of this combination was only 4%. Infants with invasive candidiasis had increased mortality (OR 2.2 [1.3-3.6]).
CONCLUSIONS: Invasive candidiasis is uncommon in infants >1500 g birth weight. Infants at greatest risk are those exposed to broad-spectrum antibiotics and with platelet counts of <50,000/mm.


Reference Type

Journal Article

Year Published


Journal Title

Pediatric Infectious Disease Journal


Lee, Jan Hau
Hornik, Christoph P.
Benjamin, Daniel K., Jr.
Herring, Amy H.
Clark, Reese H.
Cohen-Wolkowiez, Michael
Smith, P. Brian