Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019)
Introduction: Candidaemia is a significant problem in neonatal units and is associated with high morbidity, including long-term neurodevelopmental impairment in survivors, and high mortality of very low birth weight infants (VLBWI). Method: A retrospective cohort study amongst VLBWI admitted to the...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Clinical Epidemiology and Global Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213398423000349 |
| _version_ | 1827970126861828096 |
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| author | Tanusha D. Ramdin Vindana Chibabhai Robin T. Saggers Rossella M. Bandini Daynia E. Ballot |
| author_facet | Tanusha D. Ramdin Vindana Chibabhai Robin T. Saggers Rossella M. Bandini Daynia E. Ballot |
| author_sort | Tanusha D. Ramdin |
| collection | DOAJ |
| description | Introduction: Candidaemia is a significant problem in neonatal units and is associated with high morbidity, including long-term neurodevelopmental impairment in survivors, and high mortality of very low birth weight infants (VLBWI). Method: A retrospective cohort study amongst VLBWI admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa, from 1 January 2013 to 31 December 2019. All VLBWI were born at the hospital or transferred to the neonatal unit from birth to day 28 of life with blood culture confirmed candidaemia. Results: During the study period, 3414 VLBWI were admitted to the unit. Of these, 5.12% (n = 176) developed culture confirmed candidaemia. The incidence was 5.1 per 1000 admissions. The most common species, which persisted throughout the study period, was Candida parapsilosis, followed by Candida albicans. C. parapsilosis peaked in 2018 while C. albicans peaked in 2015. Emergence of C. auris occurred in 2019. Important risk factors associated with the development of candidaemia included necrotizing enterocolitis (p < 0.001, OR 4.63 [3.29–6.54]), surgery (p < 0.001 OR 7.02 [4.48–11.12]), conventional ventilation (p < 0.001, OR 6.23 [4.48–8.68]), patent ductus arteriosus (p < 0.001, OR 3.81 [2.67–5.44]), intraventricular haemorrhage (p < 0.001, OR 3.32 [2.99–5.44]) and prolonged hospital stay (p < 0.001). Mortality was not statistically different (p = 0.80 OR 0.95[0.68–1.31]) between the two groups. Conclusion: There is a high incidence of candidaemia in the neonatal unit. Several modifiable risk factors including improved antifungal stewardship and prevention of candidaemia with oral or systemic antifungal prophylaxis may decrease the incidence of candidaemia, and associated morbidity. |
| first_indexed | 2024-04-09T18:49:07Z |
| format | Article |
| id | doaj.art-14892828c63d4f9a91977394d65a1299 |
| institution | Directory Open Access Journal |
| issn | 2213-3984 |
| language | English |
| last_indexed | 2024-04-09T18:49:07Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Epidemiology and Global Health |
| spelling | doaj.art-14892828c63d4f9a91977394d65a12992023-04-10T04:03:56ZengElsevierClinical Epidemiology and Global Health2213-39842023-03-0120101247Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019)Tanusha D. Ramdin0Vindana Chibabhai1Robin T. Saggers2Rossella M. Bandini3Daynia E. Ballot4Neonatal Unit, Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and School of Clinical Medicine, University of the Witwatersrand, South Africa; Corresponding author. Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, 7 York Road, Parktown, 2193, Johannesburg, South Africa.Department of Clinical Microbiology and Infectious Diseases, National Health Laboratory Service (NHLS), School of Pathology, University of the Witwatersrand, South AfricaNeonatal Unit, Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and School of Clinical Medicine, University of the Witwatersrand, South AfricaProject for Improving Neonatal Care (PRINCE), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South AfricaProject for Improving Neonatal Care (PRINCE), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South AfricaIntroduction: Candidaemia is a significant problem in neonatal units and is associated with high morbidity, including long-term neurodevelopmental impairment in survivors, and high mortality of very low birth weight infants (VLBWI). Method: A retrospective cohort study amongst VLBWI admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa, from 1 January 2013 to 31 December 2019. All VLBWI were born at the hospital or transferred to the neonatal unit from birth to day 28 of life with blood culture confirmed candidaemia. Results: During the study period, 3414 VLBWI were admitted to the unit. Of these, 5.12% (n = 176) developed culture confirmed candidaemia. The incidence was 5.1 per 1000 admissions. The most common species, which persisted throughout the study period, was Candida parapsilosis, followed by Candida albicans. C. parapsilosis peaked in 2018 while C. albicans peaked in 2015. Emergence of C. auris occurred in 2019. Important risk factors associated with the development of candidaemia included necrotizing enterocolitis (p < 0.001, OR 4.63 [3.29–6.54]), surgery (p < 0.001 OR 7.02 [4.48–11.12]), conventional ventilation (p < 0.001, OR 6.23 [4.48–8.68]), patent ductus arteriosus (p < 0.001, OR 3.81 [2.67–5.44]), intraventricular haemorrhage (p < 0.001, OR 3.32 [2.99–5.44]) and prolonged hospital stay (p < 0.001). Mortality was not statistically different (p = 0.80 OR 0.95[0.68–1.31]) between the two groups. Conclusion: There is a high incidence of candidaemia in the neonatal unit. Several modifiable risk factors including improved antifungal stewardship and prevention of candidaemia with oral or systemic antifungal prophylaxis may decrease the incidence of candidaemia, and associated morbidity.http://www.sciencedirect.com/science/article/pii/S2213398423000349CandidaemiaVery low birth weightLow middle-income country settingModifiableRisk factors |
| spellingShingle | Tanusha D. Ramdin Vindana Chibabhai Robin T. Saggers Rossella M. Bandini Daynia E. Ballot Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019) Clinical Epidemiology and Global Health Candidaemia Very low birth weight Low middle-income country setting Modifiable Risk factors |
| title | Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019) |
| title_full | Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019) |
| title_fullStr | Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019) |
| title_full_unstemmed | Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019) |
| title_short | Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019) |
| title_sort | epidemiology risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary south african hospital over a 7 year period 2013 2019 |
| topic | Candidaemia Very low birth weight Low middle-income country setting Modifiable Risk factors |
| url | http://www.sciencedirect.com/science/article/pii/S2213398423000349 |
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