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BMC Infect Dis. 2009; 9: 183,
PMCID: PMC2788568
Characteristics and Outcome of
Infants with Candiduria in Neonatal
Intensive Care - A Pediatric
Investigators Collaborative Network
on Infections in Canada (PICNIC)
Study.
Joan L Robinson, H Dele Davies,
Michelle Barton, Karel O'Brien, Kim
Simpson, Elizabeth Asztalos, Anne
Synnes, Earl Rubin, Nicole Le Saux,
Charles Hui, Joanne M Langley, Reg
Sauve, Louis de Repentigny, Lajos
Kovacs, Ben Tan, and Susan E
Richardson.
The purpose of this study was to
describe the presentation, therapy,
and prognosis of candidal urinary
tract infection (UTI) in infants in
the neonatal intensive care unit
(NICU) in the absence of documented
extra-renal infection at
presentation. Isolation of candida
from the urine of newborns can
be indicative of contamination or of
urinary tract infection. Previous
studies have explored the
epidemiology and clinical course of
invasive candidiasis in neonatal
intensive care units, but it is not
clear how often candidal UTI is a
precursor to candidemia or to
candidal infection at other sites.
This prospective cohort study was
performed over a thirty month
period, in thirteen tertiary level
neonatal intensive care units in
nine Canadian cities. Thirty infants
with candidal urinary tract
infection, without documented
evidence of extra-renal infection,
and that met the study criteria,
were enrolled. Many of the in-term
or near-term infants had major
congenital abnormalities of the
heart or kidneys. Hospitals were
instructed to follow their usual
protocols for the diagnosis and
treatment of candidal infection
during the study. In the case of
deaths, local investigators were
asked to determine if
Candida
infection contributed to death.
Demographic and clinical data were
collected and entered into a
database. Data was analyzed using
SAS analytical software.
The median gestational age of the
infants was 35 weeks (range 24 - 41
weeks) and the median birth weight
was 2595 grams (range 575 - 4255
grams). Ten of the infants were
admitted to the NUCU with congenital
heart disease, eight with
respiratory distress, five with
renal disease, three with sepsis,
two with gastrointestinal disease,
and two with trisomy 21 (a
chromosome disorder). The median age
at diagnosis of candidal UTI was
sixteen days. Treatment varied, but
fluconazole and either amphotericin
B deoxycholate or lipid-based
amphotericin B, were used most
frequently. Extra-renal candidiasis
subsequently developed in four
infants. In two of these,
dissemination happened during
prolonged courses of anti-fungal
therapy. There were nine deaths
among the 30 infants in the study,
all in infants with significant
underlying conditions (seven with
congenital heart disease and two
with trisomy 21). In three of these
deaths,
Candida
infection was thought to be a
contributing factor.
This study concluded that Candidal
UTI in the NICU population occurs
both in term infants with congenital
abnormalities and in preterm
infants, and is associated with
renal parenchymal disease and
extra-renal dissemination. The
results suggest a lack of
distinguishing clinical or
laboratory features at diagnosis, a
high rate of abnormalities on renal
ultrasonography, and a significant
proportion of the total mortality
related to
Candida
infection.
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