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45 Trends in incidence of central line-associated bloodstream infections due to Candida spp. among Neonatal Intensive Care Unit patients in the United States, 1999–2009

Saturday, April 2, 2011: 11:15 AM
Coronado A (Hilton Anatole)
Amit S. Chitnis, MD, MPH , Centers for Disease Control and Prevention, Atlanta, GA
Shelley Magill, MD, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Jonathan Edwards, MStat , Centers for Disease Control and Prevention, Atlanta, GA
Tom Chiller, MD , Centers for Disease Control and Prevention, Atlanta, GA
Scott Fridkin, MD , Centers for Disease Control and Prevention, Atlanta, GA
Fernanda Lessa, MD, MPH , Centers for Disease Control and Prevention, Atlanta, GA

Background: Patients in neonatal intensive care units (NICUs) are at high-risk for invasive infections due to Candida spp., including bloodstream infections (BSI). Earlier reports found Candida BSI rates in neonates < 1000 grams (g) to be decreasing in U.S. NICUs.  We examined whether this trend has continued in more recent years as prophylaxis to prevent invasive Candida infections becomes more common.

Objective: Assess overall and birthweight-specific trends in incidence of Candida CLABSI in U.S. NICUs from 1999-2009.

Methods: We analyzed central line-associated BSI (CLABSI)  surveillance data reported to the National Nosocomial Infections Surveillance system from 1999–2004, and to the National Healthcare Safety Network from 2006-2009. Overall and birthweight-specific pooled-mean incidence rates for CLABSI due to Candida albicans, non-albicans Candida spp., and all Candida spp. were calculated across all NICUs for each calendar year.  We used Poisson regression to model trends in overall and birthweight-specific pooled-mean incidence rates, and to conduct a sensitivity analysis to confirm observed trends when data were limited to NICUs that contributed at least 1 month of data and at least 50 central-line days during each year of the analysis period. 

Results: Overall, 399 NICUs reported 2,931,104 central-line days and 1,407 Candida CLABSI from 1999-2009.  Of these CLABSI, 706 (50%) were due to C. albicans; 970 (69%), 165 (12%), 141 (10%), 131 (9%) occurred among neonates < 1000 g, 1001-1500 g, 1501-2500 g, and > 2500 g at birth, respectively.   The overall incidence of CLABSI per 10,000 central-line days decreased significantly from 1999 to 2009 for C. albicans (5.3 vs. 0.9; P < 0.01), non-albicans Candida spp. (3.9 vs. 1.0; P < 0.01), and all Candida spp. (9.2 vs. 2.0; P<0.01). When examining birthweight categories separately, the incidence decreased across all birthweights; however, statistically significant decreases occurred for C. albicans CLABSI in all birthweight categories except > 2500 g, and for non-albicans Candida spp. CLABSI in all birthweight categories except 1501-2500 g (Figure).  Sensitivity analysis confirmed observed trends in the overall incidence of CLABSI.

Conclusions: Rates of Candida CLABSI decreased substantially from 1999-2009 with similar decreases observed among C. albicans and non-albicans Candida spp.; whether these decreases are due to better adherence to CLABSI prevention practices or widespread use of antifungal prophylaxis needs further evaluation.