Risk factors for Candida infections in a neonatal intensive care unit in Costa Rica

Objective: To identify potential risk factors associated with Candida infections and compare these risk factors between patients who both died and survived. Study design: A group of patients with positive Candida spp. blood cultures admitted to a neonatal intensive care unit (NICU) in Costa Rica between January 1994 and December 1998. Cases were identified through a computerized search of the microbiology laboratory's database on blood cultures. Results: One hundred and ten newborns were identified. Sixty-six patients (60%) were mate; 46 (62%) were preterm infants. Thirty-seven (34%) patients died. Twenty (54%) of them died within three days of the candidemia diagnosis and 17 had disseminated Candida infection on autopsy. Candida albicans and Candida tropicalis were isolated in 90% and 10% of blood cultures, respectively. Mean +/- SD (range) number of days from admission to NICU to the initial positive blood culture were 13.5 +/- 8.5 (1-30) days. Most patients had at least two positive blood cultures (range 1-8). Median (range) days for the sterilization of blood culture were four (1-25) days. Significant differences in survival were identified in patients with axillary-inguinal lesions, apnea and seizures. Conclusions: Invasive fungal infections are frequent in NICU. Future case-control prospective studies should be carried out to confirm the findings from this report. (c) 2004 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.