Systemic Candidiasis in Extremely Low Birth Weight Infants Receiving Topical Petrolatum Ointment for Skin Care: A Case–Control Study

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Abstract
Background and Objective. An increase in the incidence of systemic candidiasis (SC) followed a change in skin care for extremely low birth weight (ELBW) infants in our neonatal intensive care unit (NICU). We sought to determine whether the use of topical petrolatum ointment (TPO) for skin care of ELBW infants was associated with risk for SC. Study Design. Case–control study. Setting. A 48-bed NICU in a private hospital in Houston, Texas. Patients. Ten ELBW infants with and 30 without SC admitted to the NICU from December 1, 1997 through July 31, 1998. Methods. ELBW infants with SC were identified using hospital microbiology and infectious disease consultation databases. A case was defined as an infant weighing ≤1000 g at birth withCandidaspp isolated from a normally sterile body site. Three infants without SC were matched to each case by birth weight, admission date, and survival to the age of SC onset for the case. Data were collected by retrospective medical record review. Molecular analysis of Candida isolates was performed by karyotyping and restriction fragment length polymorphism using pulsed-field gel electrophoresis. Results. Case infants had a mean (± standard deviation) age of onset of 21.5 ± 24 days. Infants with SC and controls did not differ in birth weight, gestational age, or duration of therapy with steroids, antibiotics, insulin, or total parenteral nutrition. Although cases were more likely to be born vaginally and had a longer duration endotracheal intubation than controls, these differences were not significant. The odds ratio for skin care with TPO in case infants versus control infants was 11 (95% confidence interval: 1.9–63). Skin care with TPO was discontinued and the incidence of SC decreased to baseline. Several Candidaspp and genetic profiles were identified, suggesting that there was not a common source outbreak. Conclusions. We conclude that the use of TPO promoted an increase in the incidence of SC in ELBW infants. Additional investigation of potential infectious risks for ELBW infants receiving TPO skin care is warranted.