Epidemiology and clinical outcome of candidaemia among Jordanian newborns over a 10-year period

Invasive Candida Infections in Neonates after Major Surgery: Current Evidence and New Directions

Infections represent a serious health problem in neonates. Invasive Candida infections (ICIs) are still a leading cause of mortality and morbidity in neonatal intensive care units (NICUs). Infants hospitalized in NICUs are at high risk of ICIs, because of several risk factors: broad spectrum antibiotic treatments, central catheters and other invasive devices, fungal colonization, and impaired immune responses. In this review we summarize 19 published studies which provide the prevalence of previous surgery in neonates with invasive Candida infections. We also provide an overview of risk factors for ICIs after major surgery, fungal colonization, and innate defense mechanisms against fungi, as well as the roles of different Candida spp., the epidemiology and costs of ICIs, diagnosis of ICIs, and antifungal prophylaxis and treatment.

The epidemiology of Candida species in the Middle East and North Africa

In recent decades, the epidemiology of invasive candidiasis (IC) has progressively changed worldwide. This notably includes emergence of several Candida species. Although some surveillance programs provided global trends in IC epidemiology, data from countries from the Middle East and North Africa (MENA) remain scarce. In this manuscript, we reviewed the existing available data on the epidemiology of Candida species associated with IC, particularly candidemia, in MENA region regarding species distribution. As witnessed worldwide, an evident shift of Candidaalbicans towards non-albicansCandida (NAC) has been observed in the MENA region. The worrying emergence of multi-drug resistant Candida species in MENA calls for a better understanding of their epidemiology. This represents an essential prerequisite for the implementation of effective infection control strategies and surveillance systems to prevent IC among high-risk patients.

Laboratory-confirmed, health care-associated bloodstream infections in Jordan: a matched cost and length of stay study

BACKGROUND

No studies have been carried out in Jordan to examine length of stay (LOS) and extra cost associated with health care-associated bloodstream infections (HCABSIs). This study aims to estimate the extra LOS and cost associated with HCABSIs among adult hospitalized Jordanian patients.

METHODS

Five-year data were retrieved from 1 large university-affiliated hospital in Jordan. Matched case-control design was used in this study. Cases were determined based on confirmed positive blood culture after 48 hours of admission. Matching criteria were age (±5 years), gender, admission diagnosis, and LOS in comparison group equal to the LOS (±5%) before blood culture for the case group.

RESULTS

Of the total 445 infected patients 125 (28.1%) were matched with uninfected patients. The mean LOS after infection for cases was 12.1 days (standard deviation [SD] = 17.2) compared with 8.3 (SD = 7.9) days for the controls (P = .02). The total mean inflation-adjusted charges for cases was M (mean) = US $7,426, SD = $7,252 compared with M = $3,274, SD = $4,209 for controls, P < .001. Using multiple regression modeling, LOS after acquiring HCABSIs, admission to critical care units, and being infected with HCABSIs were significant predictors of patients' total charges.

CONCLUSION

Figures generated from this can be used to inform health care researchers, policy makers, and professionals about the impact of HCABSIs.

Risk factors for invasive candidiasis in infants >1500 g birth weight

BACKGROUND

We describe the incidence, risk factors and outcomes of invasive candidiasis in infants >1500 g birth weight.

METHODS

We conducted a retrospective cohort study of infants >1500 g birth weight discharged from 305 neonatal intensive care units in the Pediatrix Medical Group from 2001 to 2010. Using multivariable logistic regression, we identified risk factors for invasive candidiasis.

RESULTS

Invasive candidiasis occurred in 330 of the 530,162 (0.06%) infants. These were documented from positive cultures from ≥1 of these sources: blood (n = 323), cerebrospinal fluid (n = 6) or urine from catheterization (n = 19). Risk factors included day of life >7 (odds ratio [OR]: 25.2; 95% confidence interval: 14.6-43.3), vaginal birth (OR: 1.6 [1.2-2.3]), exposure to broad-spectrum antibiotics (OR: 1.6 [1.1-2.4]), central venous line (OR: 1.8 [1.3-2.6]) and platelet count <50,000/mm (OR: 3.7 [2.1-6.7]). All risk factors had poor sensitivities, low positive likelihood ratios and low positive predictive values. The combination of broad-spectrum antibiotics and low platelet count had the highest positive likelihood ratio (46.2), but the sensitivity of this combination was only 4%. Infants with invasive candidiasis had increased mortality (OR: 2.2 [1.3-3.6]).

CONCLUSIONS

Invasive candidiasis is uncommon in infants >1500 g birth weight. Infants at greatest risk are those exposed to broad-spectrum antibiotics and with platelet counts of <50,000/mm(3).

Neonatal intensive care unit candidemia: epidemiology, risk factors, outcome, and critical review of published case series

Evaluation of epidemiological trends, risk factors, and clinical outcome associated with candidemia at a neonatal intensive care unit is reported. From January 2005 to December 2009, forty candidemia cases were identified. C. albicans and C. parapsilosis were the most common species recovered (69 and 24%, respectively). All C. parapsilosis strains were susceptible to antifungals, whereas, C. albicans exhibited higher resistance rates to azoles. Low birth weight, low gestational age, presence of central lines, endotracheal intubation, total parenteral nutrition, previous use of antibiotics, steroids, previous episode(s) of bacteremia and prolonged stay in intensive care unit were common features associated with candidemia. C. albicans was most often isolated from extremely low birth weight neonates as compared to non-albicans Candida (P < 0.01). Mortality rate was 35.7% and was associated with low gestational age (P < 0.01), low birth weight (P < 0.01), and presence of renal failure (P < 0.05). Furthermore, a critical review of recent published case series is presented.

Epidemiological characteristics of Candida species colonizing oral and rectal sites of Jordanian infants

BACKGROUND

There is evidence that Candida colonization contributes to increasing invasion of candidiasis in hospitalized neonates. Few studies investigated the epidemiology and risk factors of Candida colonization among hospitalized and non-hospitalized infants. This prospective study investigated the major epidemiological characteristics of Candida species colonizing oral and rectal sites of Jordanian infants.

METHODS

Infants aged one year or less who were examined at the pediatrics outpatient clinic or hospitalized at the Jordan University Hospital, Amman, Jordan, were included in this study. Culture swabs were collected from oral and rectal sites and inoculated on Sabouraud dextrose agar. All Candida isolates were confirmed by the Remel RapID yeast plus system, and further investigated for specific virulence factors and antifungal susceptibility MIC using E-test. Genotyping of C. albicans isolates was determined using random amplified polymorphic DNA (RAPD) analysis method.

RESULTS

A total of 61/492 (12.4%) infants were colonized with Candida species by either their oral/rectal sites or both. Rectal colonization was significantly more detected than oral colonization (64.6% verses 35.4%), particularly among hospitalized infants aged more than one month. The pattern and rates of colonization were as follows: C. albicans was the commonest species isolated from both sites and accounted for 67.1% of all isolates, followed by C.kefyr (11.4%), each C. tropicalis and C. glabrata (8.9%) and C. parapsilosis (3.8%). A various rates of Candida isolates proved to secrete putative virulence factors in vitro; asparatyl proteinase, phospholipase and hemolysin. C. albicans were associated significantly (P < 0.05) with these enzymes than other Candida species. All Candida isolates were susceptible to amphotericin B and caspofungin, whereas 97% of Candida species isolates were susceptible to fluconazole using E-test. The genetic similarity of 53 C. albicans isolates as demonstrated by dendrogram revealed the presence of 29 genotypes, and of these one genotype accounted for 22% of the isolates.

CONCLUSION

This study presents important epidemiological features of Candida colonization of Jordanian infants.