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Unidades de Investigación
Trabajos presentados y publicados
Candidemia: a case-control
study in a Neonatal Intensive Care Unit.
Pooli L, PeredaR, Califano G, Rial M.J.,
Nocetti Fasolino M, Giudici
L,Martin M.T, Alarcón N. Children 's Hospital Pedro
Elizalde.Montes de
Oca 40. Buenos Aires. Argentina
Presentado en el 9th International
Congress on Infectious Diseases. Buenos Aires, Argentina.
10-13 de abril de 2000.
Candidemia (C) is an illness of the sick
newborns or very low birth weight (VLBW). Its frequency
has increased in the last few years due to a longer survival
of the high-risk newborn. The prolonged therapy with antibiotics
(ATB), invasive procedures, total parental nutrition (TPN)
and inmunologic immaturity would condition this situation.
Objectives: 1) Description of the characteristics
and mortality in the population of patients with C in the
NICU of the Children's Hospital Pedro de Elizalde (HGNPE),
2) identification of Candida species involved and 3) Analysis
of the association with risk factors (RF): admission weight
(AW) to the NICU equal or below 1500g, history of high risk
surgery (HRS), TPN and assisted mechanic ventilation (AMV).
Methods: a case-control study was made over
a population of 896 patients discharged from the NICU between
1/1/97 and 09/30/99. Case was defined as every patient who
developed 1 or more positive blood cultures for Candida,
using the lisis-centrifugation method with saponine 5%;
species were typified with agar-milk chromogenic medium
and Api C32. The control group was formed with the two following
patients to each case discharged from
the NICU. The information was taken from the file of each
patient and from the hospital Bacteriology Lab records;
data were processed with the Epi-Info 6.0 programme; we
discarded the analysis of periods with central catheter
because of an inconstant register of this fact. The comparison
of qualitative variables was done with x2 test and quantitative
variables were compared with t test. Level of signification
was.05.
Results: 30 cases with C were assessed and
60 controls selected. Among cases 18 were female and 12
were male; gestational age (GA) x= 35 weeks; AW x= 2127,5g;
average internation days= 70,5; days previous to diagnosis
of C x= 33,4. Eighteen infants suffered HRS; 27 newborns
received AMV during x= 17,6 days and 25 infants received
TPN during x=23,8 days. Every case received ATB therapy
during x= 51,2 days; ATB were administered on average 33
days previous to diagnosis of C. C.albicans was isolated
in 17 cases, C parapsilosis in 7 cases and C. tropicalis
in 6 cases. Ten cases died (mortality: 33,3%). Among controls,
15 were female and 45 were male: GA x= 37,9 weeks, AW x=
3187 g, internation days x= 18,7, HRS 4 patients. Ten patients
of the control group received AMV x= 1,6 days and 10 infants
received TPN during x=2,4 days. 76,6% of the control group
received ATB therapy during x= 11,8 days. Mortality was
6,7%. There was significant
difference between the x for GA, AW, period with ATB, AMV
and TPN. The OR found in the qualitative analysis was AW
equal or below 1500g 9,5 (2,09-49,02), HRS 21 (5,33-90,8),
AMV 45 (10,09-233,22), TPN 31,25 (7,8-137,03) and mortality
7 (1,74-30,36).
Conclusions: cases differed from controls
in GA, AW, length of ATB therapy, AMV and TPN and mortality.
The RF associated were history of AW equal or below 1500g,
HRS, TPN and AMV. C. albicans was the type most frequently
found
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