Fatores associados a letalidade na fungemia neonatal em UTI de hospital de ensino na Região Norte do Brasil

Abstract

Candidemia is one of the most common nosocomial infections in intensive care units. In newborns, especially premature very low birth weight (1500 g <) and extremely low birth weight (1000g <) with candidemia is an important cause of morbidity and mortality. This study aimed to evaluate the risk factors for candidemia-related mortality, set the overall mortality and mortality attributed to candidemia in neonates hospitalized in a referral hospital maternal and child health in northern Brazil during the observation period January 2008 to December 2010. In order retrospective study was conducted nested case-control study for risk factors associated with death and case-control analysis of mortality attributed to, by reviewing the microbiology and corresponding clinical records of neonates with a confirmed diagnosis of candidemia by blood culture. The Blood Stream Infection by Candida spp occurred in 34 neonates, of which about 58.8% with weight equal to or less than 1,500 g and 41.2% over 1500 g. Gestational age was equal to or below 32 weeks in 38.2% of newborns and approximately 61.8% over 32 weeks. Candida albicans was identified in 9 patients (26.5%), Candida parapsilosis in 9 patients (26.5%), Candida glabrata in one patient (2.9%) and 15 patients (44.1%) there was no identifying the species of Candida. As a risk factor associated with lethality venous dissection was present in 8 patients (23.5%) p = 0.0331. Patients with fungemia had a chance of approximately 12 times more likely to evolve to death compared to controls without fungemia. Mortality attributed to fungemia was 26.4% and overall mortality for candidemia was 52.9%. The data showed that the venous dissection was a significant risk factor for mortality in neonates with candidemia. Other risk factors were not associated with mortality. The occurrence of fungemia significantly increases the chance of a premature newborn hospitalized in the intensive care unit death evolve independent of any other clinical variable.