Abstract | OBJECTIVE: METHODS: A multicenter, retrospective, cohort study was conducted of neonatal intensive care unit patients (N = 6172) who had a blood culture (N = 21,233) after day of life 3 and whose birth weight was <or=1250 g. We performed multivariable conditional logistic regression of risk factors for candidemia. From the regression modeling coefficients, we developed a candidemia score. RESULTS: In multivariable modeling, thrombocytopenia (odds ratio [OR]: 3.56; 95% confidence interval [CI]: 2.68-4.74) and cephalosporin or carbapenem use in the 7 days before obtaining the blood culture (OR: 1.77; 95% CI: 1.33-2.29) were risk factors for subsequent candidemia. Children who were 25 to 27 weeks' estimated gestational age (OR: 2.02; 95% CI: 1.52-3.05) and children who were born at <25 weeks (OR: 4.15; 95% CI: 3.12-6.29) were at higher risk of developing candidemia than were children who were born at >or=28 weeks. We developed a candidemia score on the basis of the ORs from the multivariable model. Children with a candidemia score >or=2 points were classified as having a "positive" score, and a score of >or=2 points had a sensitivity of 85% and a specificity of 47%. CONCLUSIONS: We developed a clinical predictive model for neonatal candidemia with high sensitivity and moderate specificity for candidemia. On the basis of our model, when a physician obtains a blood culture, the physician should consider providing antifungal therapy to neonates who are <25 weeks' estimated gestational age and to neonates who have thrombocytopenia at the time of blood culture. In addition, if a physician obtains a blood culture from a child who is 25 to 27 weeks' estimated gestational age and is not thrombocytopenic but has a history of third-generation cephalosporin or carbapenem exposure in the 7 days before the blood culture, then the physician should consider administration of empirical antifungal therapy.
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Authors | Daniel K Benjamin Jr, Elizabeth R DeLong, William J Steinbach, Charles M Cotton, Thomas J Walsh, Reese H Clark |
Journal | Pediatrics
(Pediatrics)
Vol. 112
Issue 3 Pt 1
Pg. 543-7
(Sep 2003)
ISSN: 1098-4275 [Electronic] United States |
PMID | 12949281
(Publication Type: Journal Article, Multicenter Study, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
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Topics |
- Antifungal Agents
(therapeutic use)
- Candida albicans
(drug effects, growth & development, isolation & purification)
- Candidiasis
(blood, complications, drug therapy, mortality)
- Cohort Studies
- Female
- Fungemia
(blood, etiology, mortality, prevention & control)
- Gestational Age
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Very Low Birth Weight
(blood)
- Intensive Care Units, Neonatal
(statistics & numerical data)
- Male
- Multivariate Analysis
- Predictive Value of Tests
- Retrospective Studies
- Risk Factors
- Sensitivity and Specificity
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