PMID- 12949295
OWN - NLM
STAT- MEDLINE
DCOM- 20031024
LR  - 20190605
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Linking)
VI  - 112
IP  - 3 Pt 1
DP  - 2003 Sep
TI  - Neonatal candidemia and end-organ damage: a critical appraisal of the literature 
      using meta-analytic techniques.
PG  - 634-40
AB  - OBJECTIVE: Neonatal candidemia is an increasing cause of infant morbidity and 
      mortality. We evaluated the current medical literature in an effort to critique 
      the literature and to document the reported prevalences of end-organ damage after 
      neonatal candidemia. METHODS: We analyzed all peer-reviewed articles of neonatal 
      candidemia published in the English language; inclusion criteria included a 
      cohort limited to all neonatal intensive care unit admissions or all episodes of 
      candidemia in neonates. Articles that also incorporated older patients, did not 
      define a numerator and a denominator for at least 1 form of end-organ damage, 
      included patients from other reports, or did not include all episodes of 
      candidemia in the source population were excluded from the analysis. RESULTS: 
      Thirty-four articles reported episodes of candidemia and mortality; 21 articles 
      reported prevalence for at least 1 form of end-organ damage. Only 4 (19%) of 21 
      articles reported prevalence for >4 forms of end-organ damage from the following 
      list: endophthalmitis, meningitis, brain parenchyma invasion, endocarditis, renal 
      abscesses, positive cultures from other normally sterile body fluids, or 
      hepatosplenic abscesses. The median reported prevalence of endophthalmitis was 3% 
      (interquartile range [IQR]: 0%-17%), of meningitis was 15% (IQR: 3%-23%), of 
      brain abscess or ventriculitis was 4% (IQR: 3%-21%), of endocarditis was 5% (IQR: 
      0%-13%), of positive renal ultrasound was 5% (IQR: 0%-14%), and of positive urine 
      culture was 61% (IQR: 40%-76%). The medical literature concerning end-organ 
      evaluation after episodes of neonatal candidemia is heterogeneous and consists 
      largely of single-center retrospective studies. Year that the data were collected 
      and prevalence of neonates infected with Candida albicans were associated with 
      observed heterogeneity. CONCLUSIONS: Given the heterogeneity of the medical 
      literature, precise estimates of the frequencies of end-organ damage are not 
      possible and a prospective multicenter trial is warranted, but the data from the 
      published literature suggest that the prevalence of neonates with end-organ 
      damage not only is greater than 0 but also is high enough that until such a 
      prospective trial is completed, end-organ studies should be considered before the 
      conclusion of antifungal therapy.
FAU - Benjamin, Daniel K Jr
AU  - Benjamin DK Jr
AD  - Department of Pediatrics, Duke University, Durham, North Carolina, USA. 
      danny.benjamin@duke.edu
FAU - Poole, Charles
AU  - Poole C
FAU - Steinbach, William J
AU  - Steinbach WJ
FAU - Rowen, Judith L
AU  - Rowen JL
FAU - Walsh, Thomas J
AU  - Walsh TJ
LA  - eng
GR  - R03HD42940-01/HD/NICHD NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Multicenter Study
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
SB  - IM
MH  - Candida albicans/isolation & purification
MH  - Candidiasis/*epidemiology
MH  - Fungemia/*epidemiology
MH  - Humans
MH  - Infant, Newborn
MH  - Meninges/blood supply/microbiology/*pathology
MH  - Meningitis/blood/epidemiology/microbiology
MH  - Prevalence
EDAT- 2003/09/02 05:00
MHDA- 2003/10/25 05:00
CRDT- 2003/09/02 05:00
PHST- 2003/09/02 05:00 [pubmed]
PHST- 2003/10/25 05:00 [medline]
PHST- 2003/09/02 05:00 [entrez]
AID - 10.1542/peds.112.3.634 [doi]
PST - ppublish
SO  - Pediatrics. 2003 Sep;112(3 Pt 1):634-40. doi: 10.1542/peds.112.3.634.