Trends in the incidence of Candida central line-associated bloodstream infections (CLABSIs) in NICU

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Intravenous literature: Chitnis, A.S., Magill, S.S., Edwards, J.R., Chiller, T.M., Fridkin, S.K. and Lessa, F.C. (2012) Trends in Candida Central Line-Associated Bloodstream Infections Among NICUs, 1999–2009. Pediatrics. 130(1), p.e46-e52.

Abstract:

OBJECTIVES: To assess trends in incidence of Candida spp. central line-associated bloodstream infections (CLABSIs) in US NICUs, 1999–2009.

METHODS: Data from NICUs participating in the National Nosocomial Infections Surveillance (1999–2004) and National Healthcare Safety Network (2006–2009) were analyzed. Overall and birth weight-specific incidence rates of Candida spp. CLABSIs per 1000 central line-days were calculated. Trends in incidence were assessed by using Poisson regression, and trends in proportion of CLABSIs identified as Candida albicans were assessed by using weighted-linear regression.

RESULTS: Overall, 398 NICUs reported 1407 Candida spp. CLABSIs (706 due to C albicans) among 1400 neonates. Of the 1400 neonates, 963 (69%) were ≤1000 g at the time of birth, and 182 (13%) died. From 1999 to 2009, the overall incidence decreased significantly for CLABSIs due to Candida spp. (0.92 vs 0.2), C albicans (0.53 vs 0.09), and non-albicans Candida spp. (0.39 vs 0.1). Birth weight-specific incidence significantly decreased across all birth weight categories for C albicans. For CLABSIs due to non-albicans Candida spp., significant decreases were detected among all birth weight categories, except among neonates 1501 to 2500 g. The proportion of Candida spp. CLABSIs due to C albicans did not significantly change over time, remaining at ∼50%.

CONCLUSIONS: Incidence of Candida spp. CLABSIs decreased substantially among NICU patients, regardless of birth weight. Decreases in incidence across all birth weight categories, and not only among neonates ≤1000 g in whom antifungal prophylaxis may be more common, suggest that multiple factors contributed to the declining incidence.

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