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Mortality Associated with Candida Infections among Neonates: a Systematic Literature Review and Meta-analysis

Schweizer ML, Ward MA, Fulton D, Perencevich EN, McDanel JM, Nelson RE, Khader K, Herwaldt L, Blevins A, Diekema DJ. Mortality Associated with Candida Infections among Neonates: a Systematic Literature Review and Meta-analysis. Poster session presented at: Society for Healthcare Epidemiology of America Annual Scientific Meeting; 2016 May 18; Atlanta, GA.


Background: Infections among neonates can lead to catastrophic outcomes including prolonged hospital stays and death. An understanding of the impact of Candida species infections can inform investments in prevention, treatment and research. Materials/Methods: We conducted a systematic search in PubMed, CINAHL, Cochrane Databases, EMBASE, Scopus,, and NHS Economic Evaluation Database to identify studies published from 2000-2015. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CI) using random-effects models. We used the I2 statistic to assess heterogeneity and visually inspected funnel plots to assess the likelihood of publication bias. A CDC SHEPHERD contract funded this meta-analysis. Results: Twelve of 42,346 articles initially identified by our literature search met inclusion criteria. Most studies evaluated patients admitted to both neonatal intensive care units and general units. When results of all 12 studies were pooled, the odds of mortality among neonates with invasive Candida infections were 6 times higher than among uninfected neonates, although the results of these studies were heterogeneous (OR = 6.39; 95% CI: 3.64, 11.21; I2 = 96%). Results were similar when data from 9 studies that did not evaluate overlapping populations were analyzed (OR = 6.19; 95% CI: 3.05, 12.60; I2 = 97%; Figure). Results were more homogeneous when the 6 studies that evaluated extremely low birth weight infants were analyzed. The odds of mortality from Candida infections were lower in this group than among other infants, (OR = 2.86; 95% CI: 2.25, 3.63; I2 = 44%) possibly because extremely low birth weight infants have a high a priori mortality risk. Results were also more homogeneous when results from the 4 case-control studies were pooled (OR = 4.45; 95% CI: 2.06, 9.62; I2 = 40%). There was no evidence of publication bias. Conclusions: Candida infections are strongly associated with mortality among neonates, including extremely low birth weight infants. Further efforts should target prevention, treatment and research in this high-risk population.

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