Characteristics and outcome of infants with candiduria in neonatal intensive care - a Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study

Joan L. Robinson, H. Dele Davies, Michelle Barton, Karel O'Brien, Kim Simpson, Elizabeth Asztalos, Anne Synnes, Earl Rubin, Nicole Le Saux, Charles Hui, Joanne M. Langley, Reg Sauve, Louis de Repentigny, Lajos Kovacs, Ben Tan, Susan E. Richardson

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Abstract

Background: There is limited information in the literature on the presentation and prognosis of candidal urinary tract infection (UTI) in infants in the neonatal intensive care unit (NICU). Methods: This was a prospective cohort study performed in 13 Canadian NICUs. Infants with candidal UTI without extra-renal candidal infection at presentation were enrolled. Results: Thirty infants fit the study criteria. Median birth weight and gestational age were 2595 grams (range 575-4255) and 35 weeks (range 24-41) with 10 infants being < 30 weeks gestation. The most common primary underlying diagnosis was congenital heart disease (n = 10). The median age at initial diagnosis was 16 days (range 6-84 days). Renal ultrasonography findings were compatible with possible fungal disease in 15 of the 26 infants (58%) in whom it was performed. Treatment was variable, but fluconazole and either amphotericin B deoxycholate or lipid-based amphotericin B in combination or sequentially were used most frequently. Extra-renal candidiasis subsequently developed in 4 infants. In 2 of these 4 infants, dissemination happened during prolonged courses of anti-fungal therapy. Three of 9 deaths were considered to be related to candidal infection. No recurrences of candiduria or episodes of invasive candidiasis following treatment were documented. Conclusion: Candidal UTI in the NICU population occurs both in term infants with congenital abnormalities and in preterm infants, and is associated with renal parenchymal disease and extra-renal dissemination. A wide variation in clinical approach was documented in this multicenter study. The overall mortality rate in these infants was significant (30%). In one third of the deaths, Candida infection was deemed to be a contributing factor, suggesting the need for antifungal therapy with repeat evaluation for dissemination in infants who are slow to respond to therapy.

Original languageEnglish (US)
Article number183
JournalBMC Infectious Diseases
Volume9
DOIs
StatePublished - Nov 23 2009

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Neonatal Intensive Care
Canada
Research Personnel
Pediatrics
Infection
Kidney
Urinary Tract Infections
Neonatal Intensive Care Units
Invasive Candidiasis
Therapeutics
Mycoses
Fluconazole
Candidiasis
Amphotericin B
Candida
Birth Weight
Premature Infants
Gestational Age
Multicenter Studies
Heart Diseases

ASJC Scopus subject areas

  • Infectious Diseases

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Characteristics and outcome of infants with candiduria in neonatal intensive care - a Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study. / Robinson, Joan L.; Davies, H. Dele; Barton, Michelle; O'Brien, Karel; Simpson, Kim; Asztalos, Elizabeth; Synnes, Anne; Rubin, Earl; Le Saux, Nicole; Hui, Charles; Langley, Joanne M.; Sauve, Reg; de Repentigny, Louis; Kovacs, Lajos; Tan, Ben; Richardson, Susan E.

In: BMC Infectious Diseases, Vol. 9, 183, 23.11.2009.

Research output: Contribution to journalArticle

Robinson, JL, Davies, HD, Barton, M, O'Brien, K, Simpson, K, Asztalos, E, Synnes, A, Rubin, E, Le Saux, N, Hui, C, Langley, JM, Sauve, R, de Repentigny, L, Kovacs, L, Tan, B & Richardson, SE 2009, 'Characteristics and outcome of infants with candiduria in neonatal intensive care - a Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study', BMC Infectious Diseases, vol. 9, 183. https://doi.org/10.1186/1471-2334-9-183
Robinson, Joan L. ; Davies, H. Dele ; Barton, Michelle ; O'Brien, Karel ; Simpson, Kim ; Asztalos, Elizabeth ; Synnes, Anne ; Rubin, Earl ; Le Saux, Nicole ; Hui, Charles ; Langley, Joanne M. ; Sauve, Reg ; de Repentigny, Louis ; Kovacs, Lajos ; Tan, Ben ; Richardson, Susan E. / Characteristics and outcome of infants with candiduria in neonatal intensive care - a Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study. In: BMC Infectious Diseases. 2009 ; Vol. 9.
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abstract = "Background: There is limited information in the literature on the presentation and prognosis of candidal urinary tract infection (UTI) in infants in the neonatal intensive care unit (NICU). Methods: This was a prospective cohort study performed in 13 Canadian NICUs. Infants with candidal UTI without extra-renal candidal infection at presentation were enrolled. Results: Thirty infants fit the study criteria. Median birth weight and gestational age were 2595 grams (range 575-4255) and 35 weeks (range 24-41) with 10 infants being < 30 weeks gestation. The most common primary underlying diagnosis was congenital heart disease (n = 10). The median age at initial diagnosis was 16 days (range 6-84 days). Renal ultrasonography findings were compatible with possible fungal disease in 15 of the 26 infants (58{\%}) in whom it was performed. Treatment was variable, but fluconazole and either amphotericin B deoxycholate or lipid-based amphotericin B in combination or sequentially were used most frequently. Extra-renal candidiasis subsequently developed in 4 infants. In 2 of these 4 infants, dissemination happened during prolonged courses of anti-fungal therapy. Three of 9 deaths were considered to be related to candidal infection. No recurrences of candiduria or episodes of invasive candidiasis following treatment were documented. Conclusion: Candidal UTI in the NICU population occurs both in term infants with congenital abnormalities and in preterm infants, and is associated with renal parenchymal disease and extra-renal dissemination. A wide variation in clinical approach was documented in this multicenter study. The overall mortality rate in these infants was significant (30{\%}). In one third of the deaths, Candida infection was deemed to be a contributing factor, suggesting the need for antifungal therapy with repeat evaluation for dissemination in infants who are slow to respond to therapy.",
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AU - Robinson, Joan L.

AU - Davies, H. Dele

AU - Barton, Michelle

AU - O'Brien, Karel

AU - Simpson, Kim

AU - Asztalos, Elizabeth

AU - Synnes, Anne

AU - Rubin, Earl

AU - Le Saux, Nicole

AU - Hui, Charles

AU - Langley, Joanne M.

AU - Sauve, Reg

AU - de Repentigny, Louis

AU - Kovacs, Lajos

AU - Tan, Ben

AU - Richardson, Susan E.

PY - 2009/11/23

Y1 - 2009/11/23

N2 - Background: There is limited information in the literature on the presentation and prognosis of candidal urinary tract infection (UTI) in infants in the neonatal intensive care unit (NICU). Methods: This was a prospective cohort study performed in 13 Canadian NICUs. Infants with candidal UTI without extra-renal candidal infection at presentation were enrolled. Results: Thirty infants fit the study criteria. Median birth weight and gestational age were 2595 grams (range 575-4255) and 35 weeks (range 24-41) with 10 infants being < 30 weeks gestation. The most common primary underlying diagnosis was congenital heart disease (n = 10). The median age at initial diagnosis was 16 days (range 6-84 days). Renal ultrasonography findings were compatible with possible fungal disease in 15 of the 26 infants (58%) in whom it was performed. Treatment was variable, but fluconazole and either amphotericin B deoxycholate or lipid-based amphotericin B in combination or sequentially were used most frequently. Extra-renal candidiasis subsequently developed in 4 infants. In 2 of these 4 infants, dissemination happened during prolonged courses of anti-fungal therapy. Three of 9 deaths were considered to be related to candidal infection. No recurrences of candiduria or episodes of invasive candidiasis following treatment were documented. Conclusion: Candidal UTI in the NICU population occurs both in term infants with congenital abnormalities and in preterm infants, and is associated with renal parenchymal disease and extra-renal dissemination. A wide variation in clinical approach was documented in this multicenter study. The overall mortality rate in these infants was significant (30%). In one third of the deaths, Candida infection was deemed to be a contributing factor, suggesting the need for antifungal therapy with repeat evaluation for dissemination in infants who are slow to respond to therapy.

AB - Background: There is limited information in the literature on the presentation and prognosis of candidal urinary tract infection (UTI) in infants in the neonatal intensive care unit (NICU). Methods: This was a prospective cohort study performed in 13 Canadian NICUs. Infants with candidal UTI without extra-renal candidal infection at presentation were enrolled. Results: Thirty infants fit the study criteria. Median birth weight and gestational age were 2595 grams (range 575-4255) and 35 weeks (range 24-41) with 10 infants being < 30 weeks gestation. The most common primary underlying diagnosis was congenital heart disease (n = 10). The median age at initial diagnosis was 16 days (range 6-84 days). Renal ultrasonography findings were compatible with possible fungal disease in 15 of the 26 infants (58%) in whom it was performed. Treatment was variable, but fluconazole and either amphotericin B deoxycholate or lipid-based amphotericin B in combination or sequentially were used most frequently. Extra-renal candidiasis subsequently developed in 4 infants. In 2 of these 4 infants, dissemination happened during prolonged courses of anti-fungal therapy. Three of 9 deaths were considered to be related to candidal infection. No recurrences of candiduria or episodes of invasive candidiasis following treatment were documented. Conclusion: Candidal UTI in the NICU population occurs both in term infants with congenital abnormalities and in preterm infants, and is associated with renal parenchymal disease and extra-renal dissemination. A wide variation in clinical approach was documented in this multicenter study. The overall mortality rate in these infants was significant (30%). In one third of the deaths, Candida infection was deemed to be a contributing factor, suggesting the need for antifungal therapy with repeat evaluation for dissemination in infants who are slow to respond to therapy.

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