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Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls

BACKGROUND: This multicenter prospective study of invasive candidiasis (IC) was carried out to determine the risk factors for, incidence of, clinical and laboratory features, treatment and outcome of IC in infants of birth weight <1250 g. METHODS: Neonates <1250 g with IC and their matched con...

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Autores principales: Barton, Michelle, O’Brien, Karel, Robinson, Joan L, Davies, Dele H, Simpson, Kim, Asztalos, Elizabeth, Langley, Joanne M, Le Saux, Nicole, Sauve, Reg, Synnes, Anne, Tan, Ben, de Repentigny, Louis, Rubin, Earl, Hui, Chuck, Kovacs, Lajos, Richardson, Susan E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063435/
https://www.ncbi.nlm.nih.gov/pubmed/24924877
http://dx.doi.org/10.1186/1471-2334-14-327
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author Barton, Michelle
O’Brien, Karel
Robinson, Joan L
Davies, Dele H
Simpson, Kim
Asztalos, Elizabeth
Langley, Joanne M
Le Saux, Nicole
Sauve, Reg
Synnes, Anne
Tan, Ben
de Repentigny, Louis
Rubin, Earl
Hui, Chuck
Kovacs, Lajos
Richardson, Susan E
author_facet Barton, Michelle
O’Brien, Karel
Robinson, Joan L
Davies, Dele H
Simpson, Kim
Asztalos, Elizabeth
Langley, Joanne M
Le Saux, Nicole
Sauve, Reg
Synnes, Anne
Tan, Ben
de Repentigny, Louis
Rubin, Earl
Hui, Chuck
Kovacs, Lajos
Richardson, Susan E
author_sort Barton, Michelle
collection PubMed
description BACKGROUND: This multicenter prospective study of invasive candidiasis (IC) was carried out to determine the risk factors for, incidence of, clinical and laboratory features, treatment and outcome of IC in infants of birth weight <1250 g. METHODS: Neonates <1250 g with IC and their matched controls (2:1) were followed longitudinally and descriptive analysis was performed. Survivors underwent neurodevelopmental assessment at 18 to 24 months corrected age. Neurodevelopmental impairment (NDI) was defined as blindness, deafness, moderate to severe cerebral palsy, or a score <70 on the Bayley Scales of Infant Development 2nd edition. Multivariable analyses were performed to determine risk factors for IC and predictors of mortality and NDI. RESULTS: Cumulative incidence rates of IC were 4.2%, 2.2% and 1.5% for birth-weight categories <750 g, <1000 g, <1500 g, respectively. Forty nine infants with IC and 90 controls were enrolled. Necrotizing enterocolitis (NEC) was the only independent risk factor for IC (p = 0.03). CNS candidiasis occurred in 50% of evaluated infants, while congenital candidiasis occurred in 31%. Infants with CNS candidiasis had a higher mortality rate (57%) and incidence of deafness (50%) than the overall cohort of infants with IC. NDI (56% vs. 33%; p = 0.017) and death (45% vs. 7%; p = 0.0001) were more likely in cases than in controls, respectively. IC survivors were more likely to be deaf (28% vs. 7%; p = 0.01). IC independently predicted mortality (p = 0.0004) and NDI (p = 0.018). CONCLUSION: IC occurred in 1.5% of VLBW infants. Preceding NEC increased the risk of developing IC. CNS candidiasis is under-investigated and difficult to diagnose, but portends a very poor outcome. Mortality, deafness and NDI were independently significantly increased in infants with IC compared to matched controls.
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spelling pubmed-40634352014-06-20 Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls Barton, Michelle O’Brien, Karel Robinson, Joan L Davies, Dele H Simpson, Kim Asztalos, Elizabeth Langley, Joanne M Le Saux, Nicole Sauve, Reg Synnes, Anne Tan, Ben de Repentigny, Louis Rubin, Earl Hui, Chuck Kovacs, Lajos Richardson, Susan E BMC Infect Dis Research Article BACKGROUND: This multicenter prospective study of invasive candidiasis (IC) was carried out to determine the risk factors for, incidence of, clinical and laboratory features, treatment and outcome of IC in infants of birth weight <1250 g. METHODS: Neonates <1250 g with IC and their matched controls (2:1) were followed longitudinally and descriptive analysis was performed. Survivors underwent neurodevelopmental assessment at 18 to 24 months corrected age. Neurodevelopmental impairment (NDI) was defined as blindness, deafness, moderate to severe cerebral palsy, or a score <70 on the Bayley Scales of Infant Development 2nd edition. Multivariable analyses were performed to determine risk factors for IC and predictors of mortality and NDI. RESULTS: Cumulative incidence rates of IC were 4.2%, 2.2% and 1.5% for birth-weight categories <750 g, <1000 g, <1500 g, respectively. Forty nine infants with IC and 90 controls were enrolled. Necrotizing enterocolitis (NEC) was the only independent risk factor for IC (p = 0.03). CNS candidiasis occurred in 50% of evaluated infants, while congenital candidiasis occurred in 31%. Infants with CNS candidiasis had a higher mortality rate (57%) and incidence of deafness (50%) than the overall cohort of infants with IC. NDI (56% vs. 33%; p = 0.017) and death (45% vs. 7%; p = 0.0001) were more likely in cases than in controls, respectively. IC survivors were more likely to be deaf (28% vs. 7%; p = 0.01). IC independently predicted mortality (p = 0.0004) and NDI (p = 0.018). CONCLUSION: IC occurred in 1.5% of VLBW infants. Preceding NEC increased the risk of developing IC. CNS candidiasis is under-investigated and difficult to diagnose, but portends a very poor outcome. Mortality, deafness and NDI were independently significantly increased in infants with IC compared to matched controls. BioMed Central 2014-06-12 /pmc/articles/PMC4063435/ /pubmed/24924877 http://dx.doi.org/10.1186/1471-2334-14-327 Text en Copyright © 2014 Barton et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Barton, Michelle
O’Brien, Karel
Robinson, Joan L
Davies, Dele H
Simpson, Kim
Asztalos, Elizabeth
Langley, Joanne M
Le Saux, Nicole
Sauve, Reg
Synnes, Anne
Tan, Ben
de Repentigny, Louis
Rubin, Earl
Hui, Chuck
Kovacs, Lajos
Richardson, Susan E
Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls
title Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls
title_full Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls
title_fullStr Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls
title_full_unstemmed Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls
title_short Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls
title_sort invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063435/
https://www.ncbi.nlm.nih.gov/pubmed/24924877
http://dx.doi.org/10.1186/1471-2334-14-327
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