Top

Published in:

Open Access 01-12-2017 | Research

Risk factors for Candida parapsilosis bloodstream infection in a neonatal intensive care unit: a case-control study

Authors: Carmine Garzillo, Maria Bagattini, Lidija Bogdanović, Anna Di Popolo, Vita Dora Iula, Maria Rosaria Catania, Francesco Raimondi, Maria Triassi, Raffaele Zarrilli

Published in: Italian Journal of Pediatrics | Issue 1/2017

Abstract

Background

Candida parapsilosis is increasingly responsible for invasive candidiasis in neonates. This study investigates phenotypic and genotypic features of C. parapsilosis microbial isolates and underlying clinical conditions associated with acquisition of C. parapsilosis in a neonatal intensive care unit (NICU) in Italy.

Methods

Identification of C. parapsilosis was performed by VITEK® 2 and MALDI TOF and confirmed by analysis of internal transcribed spacer ribosomal DNA sequences. Genotyping was performed by PCR fingerprinting. Antifungal susceptibility of strains was evaluated by microdilution. A case-control study was designed to identify risk factors for C. parapsilosis bloodstream infection.

Results

During the study period (April 2009- April 2012), C. parapsilosis was responsible for 6 umbilical catheter and 11 central catheter-associated bloodstream infection in 17 neonates in the NICU. Molecular typing identified identical fingerprinting profile in all C. parapsilosis isolates from neonates. Fifteen of 17 C. parapsilosis isolates were susceptible to all antifungal drugs, two isolates were resistant to fluconazole and intermediate susceptible to itraconazole. Low birthweight, gestational age and time to exposure to assisted ventilation were risk factors for C. parapsilosis infection in neonates in the NICU at univariate and multivariate analysis.

Conclusion

C. parapsilosis bloodstream infections in the NICU were caused by a single epidemic clone. Low birthweight, gestational age and time to exposure to invasive devices, with predominance of assisted ventilation, were the clinical conditions associated with C. parapsilosis bloodstream infection in the NICU.

Available only for authorised users

Polin RA, Denson S, Brady MT. Committee on fetus and newborn; committee on infectious diseases. Epidemiology and diagnosis of health care-associated infections in the NICU. Pediatrics. 2012;129:e1104–9.CrossRefPubMed

Hooven TA, Polin RA. Healthcare-associated infections in the hospitalized neonate: a review. Early Hum Dev. 2014;90 Suppl 1:S4–6.CrossRefPubMed

Geffers C, Baerwolff S, Schwab F, Gastmeier P. Incidence of healthcare-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants. J Hosp Infect. 2008;68:214–21.CrossRefPubMed

Verstraete E, Boelens J, De Coen K, Claeys G, Vogelaers D, Vanhaesebrouck P, Blot S. Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992–2011): trends in incidence, pathogens, and mortality. Infect Control Hosp Epidemiol. 2014;35:511–8.CrossRefPubMed

Auriti C, Ronchetti MP, Pezzotti P, Marrocco G, Quondamcarlo A, Seganti G, Bagnoli F, De Felice C, Buonocore G, Arioni C. Determinants of nosocomial infection in 6 neonatal intensive care units: an Italian multicenter prospective cohort study. Infect Control Hosp Epidemiol. 2010;31:926–33.CrossRefPubMed

Crivaro V, Bogdanović L, Bagattini M, Iula VD, Catania M, Raimondi F, Triassi M, Zarrilli R. Surveillance of healthcare-associated infections in a neonatal intensive care unit in Italy during 2006–2010. BMC Infect Dis. 2015;15:152.CrossRefPubMedPubMedCentral

Benjamin Jr DK, Stoll BJ, Gantz MG, Walsh MC, Sánchez PJ, Das A, Shankaran S, Higgins RD, Auten KJ, Miller NA, et al. Eunice Kennedy Shriver national institute of child health and human development neonatal research network. Neonatal candidiasis: epidemiology, risk factors, and clinical judgment. Pediatrics. 2010;126:e865–73.CrossRefPubMedPubMedCentral

Kelly MS, Benjamin Jr DK, Smith PB. The epidemiology and diagnosis of invasive candidiasis among premature infants. Clin Perinatol. 2015;42:105–17.CrossRefPubMed

Barton M, O’Brien K, Robinson JL, Davies DH, Simpson K, Asztalos E, Langley JM, Le Saux N, Sauve R, Synnes A, et al. Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls. BMC Infect Dis. 2014;14:327.CrossRefPubMedPubMedCentral

10.

Yu Y, Du L, Yuan T, Zheng J, Chen A, Chen L, Shi L. Risk factors and clinical analysis for invasive fungal infection in neonatal intensive care unit patients. Am J Perinatol. 2013;30:589–94.CrossRefPubMed

11.

Pasqualotto AC, de Moraes AB, Zanini RR, Severo LC. Analysis of independent risk factors for death among pediatric patients with candidemia and a central venous catheter in place. Infect Control Hosp Epidemiol. 2007;28:799–804.CrossRefPubMed

12.

Guinea J. Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect. 2014;20 Suppl 6:5–10.CrossRef

13.

Pammi M, Holland L, Butler G, Gacser A, Bliss JM. Candida parapsilosis is a significant neonatal pathogen: a systematic review and meta-analysis. Pediatr Infect Dis J. 2013;32:e206–16.CrossRefPubMedPubMedCentral

14.

Sarvikivi E, Lyytikäinen O, Soll DR, Pujol C, Pfaller MA, Richardson M, Koukila-Kähkölä P, Luukkainen P, Saxén H. Emergence of fluconazole resistance in a Candida parapsilosis strain that caused infections in a neonatal intensive care unit. J Clin Microbiol. 2005;43:2729–35.CrossRefPubMedPubMedCentral

15.

Almirante B, Rodríguez D, Cuenca-Estrella M, Almela M, Sanchez F, Ayats J, Alonso-Tarres C, Rodriguez-Tudela JL, Pahissa A. Epidemiology, risk factors, and prognosis of Candida parapsilosis bloodstream infections: case-control population-based surveillance study of patients in Barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2006;44:1681–5.CrossRefPubMedPubMedCentral

16.

Rodríguez D, Almirante B, Cuenca-Estrella M, Rodríguez-Tudela JL, Mensa J, Ayats J, Sanchez F, Pahissa A. Barcelona candidemia project study group. Predictors of candidaemia caused by non-albicans Candida species: results of a population-based surveillance in Barcelona, Spain. Clin Microbiol Infect. 2010;16:1676–82.CrossRefPubMed

17.

Hoffmann-Santos HD, Paula CR, Yamamoto AC, Tadano T, Hahn RC. Six-year trend analysis of nosocomial candidemia and risk factors in two intensive care hospitals in Mato Grosso, midwest region of Brazil. Mycopathologia. 2013;176(5-6):409–15.CrossRefPubMed

18.

Manzoni P, Stolfi I, Pugni L, Decembrino L, Magnani C, Vetrano G, Tridapalli E, Corona G, Giovannozzi C, Farina D, et al. Italian task force for the study and prevention of neonatal fungal infections; Italian society of neonatology. A multicenter, randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med. 2007;356:2483–95.CrossRefPubMed

19.

NNIS System. National nosocomial infections surveillance (NNIS) system report, data summary from January 1990-May 1999, issued June 1999. A report from the NNIS system. Am J Infect Control. 1999;27:520–32.CrossRef

20.

Jarvis WR. Benchmarking for prevention: the centers for disease control and Prevention’s national nosocomial infections surveillance (NNIS) system experience. Infection. 2003;31:44–8.PubMed

21.

Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32. Erratum in: Am J Infect Control. 2008, 36:655.CrossRefPubMed

22.

Pulcrano G, Roscetto E, Iula VD, Panellis D, Rossano F, Catania MR. MALDI-TOF mass spectrometry and microsatellite markers to evaluate Candida parapsilosis transmission in neonatal intensive care units. Eur J Clin Microbiol Infect Dis. 2012;31:2919–28.CrossRefPubMed

23.

Tavanti A, Davidson AD, Gow NA, Maiden MC, Odds FC. Candida orthopsilosis and Candida metapsilosis spp. nov. to replace Candida parapsilosis groups II and III. J Clin Microbiol. 2005;43:284–92.CrossRefPubMedPubMedCentral

24.

Xu J, Ramos AR, Vilgalys R, Mitchell TG. Clonal and spontaneous origins of fluconazole resistance in Candida albicans. J Clin Microbiol. 2000;38:1214–20.PubMedPubMedCentral

25.

Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeasts; fourth informational supplement. In: CLSI document M27-S4. Wayne, PA: Clinical and Laboratory Standards Institute; 2012.

26.

The R Project for Statistical Computing. https://www.r-project.org/. Accessed 06 May 2016.

27.

Wilcox RR. Introduction to robust estimation and hypothesis testing. 2nd ed. Burlington, MA: Elsevier; 2005.

28.

Field AP, Miles J, Field Z. Discovering statistics using R. London: Sage; 2012.

29.

Munzel U, Brunner E. Nonparametric tests in the unbalanced multivariate one-way design. Biom J. 2000;42:837–54.CrossRef

30.

McLachlan GJ. Discriminant analysis and statistical pattern recognition. New York: Wiley Interscience; 2004. ISBN 0-471-69115-1. MR 1190469.

31.

Lee J, Kim HS, Shin SH, Choi CW, Kim EK, Choi EH, Kim BI, Choi JH. Efficacy and safety of fluconazole prophylaxis in extremely low birth weight infants: multicenter pre-post cohort study. BMC Pediatr. 2016;16:67.CrossRefPubMedPubMedCentral

Title: Risk factors for Candida parapsilosis bloodstream infection in a neonatal intensive care unit: a case-control study
Authors: Carmine Garzillo
Maria Bagattini
Lidija Bogdanović
Anna Di Popolo
Vita Dora Iula
Maria Rosaria Catania
Francesco Raimondi
Maria Triassi
Raffaele Zarrilli
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Italian Journal of Pediatrics / Issue 1/2017
Electronic ISSN: 1824-7288
DOI: https://doi.org/10.1186/s13052-017-0332-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for Candida parapsilosis bloodstream infection in a neonatal intensive care unit: a case-control study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

Pyridoxine dependent epilepsies: new therapeutical point of view

Neuropsychological and internalizing problems in acute central nervous system infections: a 1 year follow-up

Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy

Stunting and its determinant factors among children aged 6–59 months in Ethiopia

Efficacy and safety of early supplementation with 800 IU of vitamin D in very preterm infants followed by underlying levels of vitamin D at birth

Children with cancer: a survey on the experience of Italian primary care pediatricians