Endotracheal colonization with Candida enhances risk of systemic candidiasis in very low birth weight neonates

Objective: To determine whether growth of Candida from an endotracheal aspirate identifies a population of very low birth weight (VLBW; ≤1500 gm) neonates at increased risk of systemic candidiasis. Design: Prospective evaluation with weekly cultures of endotracheal and rectal specimens to determine colonization status. Subjects: One hundred sixteen VLBW neonates (mean birth weight, 975±23 gm, estimated gestational age, 27.6±0.2 weeks) with endotracheal tubes in place who were admitted to a level III nursery between Jan. 8 and Dec. 2, 1992. Results: Of the 116 subjects, 39 infants were colonized with Candida (34%). Thirteen neonates had growth of Candida in one or more cultures of endotracheal specimens. Eleven of these could be examined, and in five systemic disease developed (disease in 5/11 vs 2/26; relative risk=5.9; 95% confidence interval, 1.34 to 26). Eight infants were colonized with Candida in the first week of life. Seven of these could be examined, and in five systemic candidiasis developed (disease in 5/7 vs 2/30; RR=9.3; 95% confidence interval, 2.3 to 38.0). Conclusions: Colonization with Candida occurs frequently in VLBW infants. Progression from colonization to systemic infection is more common in the smallest neonates. Detection of colonization in the first week of life or the growth of Candida from an endotracheal aspirate identifies a group of VLBW neonates with an endotracheal tube in place whose risk of systemic candidiasis is increased. A prospective trial of intervention in this high-risk population is warranted.