Risk factors for candidemia in critically ill infants: a matched case-control study.

OBJECTIVE: To determine risk factors for late-onset candidemia among infants in the neonatal intensive care unit (NICU). STUDY DESIGN: We performed a matched case-control study from March 2001 to January 2003 in 2 level III-IV NICUs. Case subjects had candidemia diagnosed more than 48 hours after hospitalization. Control subjects (3 per case) were matched by study site, birth weight, study year, and date of enrollment. Potential risk factors included medical devices, medications, gastrointestinal (GI) pathology (congenital anomalies or necrotizing enterocolitis) and previous bacterial bloodstream infections (BSIs). RESULTS: Forty-five cases of candidemia occurred during the study period and accounted for 15% of BSIs. C. albicans caused 62% of infections (28/45); C. parapsilosis, 31% (14/45). Multivariate analysis revealed that catheter use (odds ratio [OR]=1.06 per day of use; 95% confidence interval [CI]=1.02 to 1.10), previous bacterial BSIs (OR=8.02; 95% CI=2.76 to 23.30) and GI pathology (OR=4.57; 95% CI=1.62 to 12.92) were significantly associated with candidemia. In all, 26/45 cases (58%) of candidemia occurred in infants who would not have qualified for fluconazole prophylaxis according to the Kaufman criteria. CONCLUSIONS: We confirmed previous risk factors (catheter-days) and identified novel risk factors (previous BSI and GI pathology) for candidemia in critically ill infants that could guide future targeted antifungal prophylaxis strategies.

Attributable costs and length of stay of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae outbreak in a neonatal intensive care unit.

OBJECTIVES: To determine the costs of the interventions aimed at controlling the 4-month outbreak and to determine the attributable length of stay (LOS) associated with infection and colonization with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. DESIGN: A retrospective cost analysis was conducted from the hospital perspective. A micro-costing approach was employed. The LOS of four groups of hospitalized patients were compared with each other. National Perinatal Information Center criteria were used to stratify infants for severity of risk. The LOS of each group was compared with that of a national sample of similarly stratified infants. SETTING: A level III-IV, 45-bed neonatal intensive care unit. PATIENTS: Infant groups were infected (n = 8), colonized (n = 14), concurrent cohort (n = 54), and prior cohort (n = 486). RESULTS: The cost of the outbreak totaled 341,751 dollars. The largest proportion of costs was related to healthcare worker time providing direct patient care (2,489 hours at a cost of 146,331 dollars). Infected and colonized neonates had longer LOS than either the concurrent cohort or the prior cohort (P < .001). Compared with the national sample, infected infants had a 48.5-day longer mean LOS (95% confidence interval [CI95], 1.7 to 95.2), whereas the prior cohort's mean LOS was 6 days shorter (CI95, -9.4 to -2.9). CONCLUSIONS: This study increases the understanding of the burden of these multidrug-resistant organisms. Further research is needed to estimate the societal costs of these infections and the cost-effectiveness of preventive interventions.