Early-onset invasive candidiasis in extremely low birth weight infants: Perinatal acquisition predicts poor outcome

Michelle Barton, Alex Shen, Karel O'Brien, Joan L. Robinson, Herbert Dele Davies, Kim Simpson, Elizabeth Asztalos, Joanne Langley, Nicole Le Saux, Reginald Sauve, Anne Synnes, Ben Tan, Louis De Repentigny, Earl Rubin, Chuck Hui, Lajos Kovacs, Yvonne C.W. Yau, Susan E. Richardson

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background. Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, ≤7 days) or compared to late-onset disease (LOD, >7 days). Methods. All extremely low birth weight (ELBW, <1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined. Results. Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31%) ELBW infants had EOD. Birth weight <750 g, gestation <25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71%) was higher than in LOD (32%) or controls (15%) (P = .0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86%) and LOD (72%), but higher than in controls (32%; P = .007). Conclusions. ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.

Original languageEnglish (US)
Pages (from-to)921-927
Number of pages7
JournalClinical Infectious Diseases
Volume64
Issue number7
DOIs
StatePublished - Apr 1 2017

Fingerprint

Invasive Candidiasis
Extremely Low Birth Weight Infant
Chorioamnionitis
Pneumonia
Mortality
Candidiasis
Low Birth Weight Infant
Foreign Bodies
Candida albicans
Birth Weight
Multicenter Studies
Cardiovascular Diseases
Mothers
Pregnancy
Infection

Keywords

  • Congenital candidiasis
  • ELB
  • Invasive candidiasis
  • Neonatal candidiasis
  • Systemic candidiasis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Early-onset invasive candidiasis in extremely low birth weight infants : Perinatal acquisition predicts poor outcome. / Barton, Michelle; Shen, Alex; O'Brien, Karel; Robinson, Joan L.; Davies, Herbert Dele; Simpson, Kim; Asztalos, Elizabeth; Langley, Joanne; Le Saux, Nicole; Sauve, Reginald; Synnes, Anne; Tan, Ben; De Repentigny, Louis; Rubin, Earl; Hui, Chuck; Kovacs, Lajos; Yau, Yvonne C.W.; Richardson, Susan E.

In: Clinical Infectious Diseases, Vol. 64, No. 7, 01.04.2017, p. 921-927.

Research output: Contribution to journalArticle

Barton, M, Shen, A, O'Brien, K, Robinson, JL, Davies, HD, Simpson, K, Asztalos, E, Langley, J, Le Saux, N, Sauve, R, Synnes, A, Tan, B, De Repentigny, L, Rubin, E, Hui, C, Kovacs, L, Yau, YCW & Richardson, SE 2017, 'Early-onset invasive candidiasis in extremely low birth weight infants: Perinatal acquisition predicts poor outcome', Clinical Infectious Diseases, vol. 64, no. 7, pp. 921-927. https://doi.org/10.1093/cid/cix001
Barton, Michelle ; Shen, Alex ; O'Brien, Karel ; Robinson, Joan L. ; Davies, Herbert Dele ; Simpson, Kim ; Asztalos, Elizabeth ; Langley, Joanne ; Le Saux, Nicole ; Sauve, Reginald ; Synnes, Anne ; Tan, Ben ; De Repentigny, Louis ; Rubin, Earl ; Hui, Chuck ; Kovacs, Lajos ; Yau, Yvonne C.W. ; Richardson, Susan E. / Early-onset invasive candidiasis in extremely low birth weight infants : Perinatal acquisition predicts poor outcome. In: Clinical Infectious Diseases. 2017 ; Vol. 64, No. 7. pp. 921-927.
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title = "Early-onset invasive candidiasis in extremely low birth weight infants: Perinatal acquisition predicts poor outcome",
abstract = "Background. Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, ≤7 days) or compared to late-onset disease (LOD, >7 days). Methods. All extremely low birth weight (ELBW, <1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined. Results. Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31{\%}) ELBW infants had EOD. Birth weight <750 g, gestation <25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71{\%}) was higher than in LOD (32{\%}) or controls (15{\%}) (P = .0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86{\%}) and LOD (72{\%}), but higher than in controls (32{\%}; P = .007). Conclusions. ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.",
keywords = "Congenital candidiasis, ELB, Invasive candidiasis, Neonatal candidiasis, Systemic candidiasis",
author = "Michelle Barton and Alex Shen and Karel O'Brien and Robinson, {Joan L.} and Davies, {Herbert Dele} and Kim Simpson and Elizabeth Asztalos and Joanne Langley and {Le Saux}, Nicole and Reginald Sauve and Anne Synnes and Ben Tan and {De Repentigny}, Louis and Earl Rubin and Chuck Hui and Lajos Kovacs and Yau, {Yvonne C.W.} and Richardson, {Susan E.}",
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T1 - Early-onset invasive candidiasis in extremely low birth weight infants

T2 - Perinatal acquisition predicts poor outcome

AU - Barton, Michelle

AU - Shen, Alex

AU - O'Brien, Karel

AU - Robinson, Joan L.

AU - Davies, Herbert Dele

AU - Simpson, Kim

AU - Asztalos, Elizabeth

AU - Langley, Joanne

AU - Le Saux, Nicole

AU - Sauve, Reginald

AU - Synnes, Anne

AU - Tan, Ben

AU - De Repentigny, Louis

AU - Rubin, Earl

AU - Hui, Chuck

AU - Kovacs, Lajos

AU - Yau, Yvonne C.W.

AU - Richardson, Susan E.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background. Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, ≤7 days) or compared to late-onset disease (LOD, >7 days). Methods. All extremely low birth weight (ELBW, <1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined. Results. Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31%) ELBW infants had EOD. Birth weight <750 g, gestation <25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71%) was higher than in LOD (32%) or controls (15%) (P = .0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86%) and LOD (72%), but higher than in controls (32%; P = .007). Conclusions. ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.

AB - Background. Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, ≤7 days) or compared to late-onset disease (LOD, >7 days). Methods. All extremely low birth weight (ELBW, <1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined. Results. Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31%) ELBW infants had EOD. Birth weight <750 g, gestation <25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71%) was higher than in LOD (32%) or controls (15%) (P = .0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86%) and LOD (72%), but higher than in controls (32%; P = .007). Conclusions. ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.

KW - Congenital candidiasis

KW - ELB

KW - Invasive candidiasis

KW - Neonatal candidiasis

KW - Systemic candidiasis

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DO - 10.1093/cid/cix001

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