CONCISE REVIEWS OF PEDIATRIC INFECTIOUS DISEASES Nosocomial Neonatal Candidiasis

As the survival of our smallest, most immature patients has increased, a concurrent increase in the length of stay on the Neonatal Intensive Care Unit (NICU) and the risk of nosocomial infection has been observed. In a representative cohort of 6000 very low birth weight (VLBW) infants (401–1500 g), 21% had blood culture-proved late onset sepsis (defined as sepsis occurring after 3 days of age). Fungal infections accounted for 12% of the episodes of late onset sepsis; Candida albicans, the third most common single organism isolated, was responsible for 6% of all such infections in this patient population. Rates of nosocomial candidemia approached 17% among the subpopulation of extremely low birth weight (ELBW) infants ( 1000 g). Unique among the NICU population is the distribution of non-C. albicans Candida species isolated from the bloodstream of infected neonates. Candida parapsilosis is the second most common yeast responsible for late onset fungemia, and Candida glabrata ranks third. Candida is an important pathogen in this fragile group of immunocompromised patients with high rates of mortality (25–30%) and morbidity (20–50%), including significant adverse neurodevelopmental outcomes.