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Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Hospital Pequeno Principe is a pediatric reference hospital with 380- beds, in Curitiba city, Parana State, south of Brazil .
Background: Candida species are important pathogen in neonatal intensive care units (NICU) especially among high risk neonates. Candidemia is a common cause of Bloodstream Infection (BSI) and it is associated with significant morbidity and mortality. Because there are few data, knowledge of the epidemiology of cases of candidemia in the neonatal period may contribute to its prevention.
Objective: to describe the epidemiology and clinical outcome associated with candidemia infections in NICU.
Methods: The study was undertaken in a quaternary pediatric hospital inBrazil . We conducted a retrospective cohort study of candidemia occurring in infants in a NICU between July 2006 and September 2009.A case was defined as a patient with a positive blood culture for Candida spp. Cases were indentified, using a own software: the Electronic System for Hospital Infection Surveillance (ESHIS) and through computerized searching of microbiology blood culture and surveillance database. Candidemia was considered contributory to mortality if death occurred within 3 days of positive blood culture.
Results: During the study period 1024 infants were hospitalized in NICU with an average of 26 neonates/month. Candidemia occurred in 10 infants, representing 0.97% of all NICU patients in 39 months of the study. C.albicans (80%) was the predominant agent followed by C.tropicalis (10%) and C.parapsilosis(10%). The average birth weight was 2.347g and the median time to candidemia was 24 days. Mechanical Ventilation (VM), Central Venous Catheter (CVC) and Total Parenteral Nutrition (TPN) were used in 80% of infants. From newborns affected 80% underwent at least one surgical procedure: surgery of digestive tract (50%);cardiac surgery (25%);neurosurgery (25%) and thoracotomy (12.5%).Leastwise one underlying medical condition was found in all infants and the most common were: congenital malformation of digestive tract (40%), congenital heart disease (30%) and prematurity (30%). Two infants died, but only 1 was considered related with candidemia, thereby the mortality rate was 10%.
Conclusions: Although the limitations due small number of our study, we find a similar data in literature and confirm that candidemia occurs in high-risk neonates, particularly those undergoing surgical procedures and associated congenital malformations.
Background: Candida species are important pathogen in neonatal intensive care units (NICU) especially among high risk neonates. Candidemia is a common cause of Bloodstream Infection (BSI) and it is associated with significant morbidity and mortality. Because there are few data, knowledge of the epidemiology of cases of candidemia in the neonatal period may contribute to its prevention.
Objective: to describe the epidemiology and clinical outcome associated with candidemia infections in NICU.
Methods: The study was undertaken in a quaternary pediatric hospital in
Results: During the study period 1024 infants were hospitalized in NICU with an average of 26 neonates/month. Candidemia occurred in 10 infants, representing 0.97% of all NICU patients in 39 months of the study. C.albicans (80%) was the predominant agent followed by C.tropicalis (10%) and C.parapsilosis(10%). The average birth weight was 2.347g and the median time to candidemia was 24 days. Mechanical Ventilation (VM), Central Venous Catheter (CVC) and Total Parenteral Nutrition (TPN) were used in 80% of infants. From newborns affected 80% underwent at least one surgical procedure: surgery of digestive tract (50%);cardiac surgery (25%);neurosurgery (25%) and thoracotomy (12.5%).Leastwise one underlying medical condition was found in all infants and the most common were: congenital malformation of digestive tract (40%), congenital heart disease (30%) and prematurity (30%). Two infants died, but only 1 was considered related with candidemia, thereby the mortality rate was 10%.
Conclusions: Although the limitations due small number of our study, we find a similar data in literature and confirm that candidemia occurs in high-risk neonates, particularly those undergoing surgical procedures and associated congenital malformations.
| *2006 | 2007 | 2008 | **2009 | Total/Mean |
| Number of patients | 154 | 306 | 343 | 221 | 1024 |
| Length of stay (days) | 14.64 | 13.87 | 13.43 | 15.98 | 14.48 |
| Candida albicans | 2 | 1 | 5 | 0 | 8 |
| Candida parapsilosis | 0 | 0 | 1 | 0 | 1 |
| Candida tropicalis | 0 | 0 | 0 | 1 | 1 |
| Surgeries | 2 | 1 | 4 | 1 | 8 |
| VM | 0 | 2 | 5 | 1 | 8 |
| TPN | 0 | 2 | 5 | 1 | 8 |
| CVC | 2 | 1 | 4 | 1 | 8 |
| * from July/2006 | |||||
| ** until September/2009 | |||||