{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:57:30Z","timestamp":1793642250218,"version":"4.5.1"},"reference-count":12,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"\n BACKGROUND<\/jats:title>\n Candida species are a leading cause of central line\u2013associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) with high associated morbidity and mortality. Data about facility-level factors associated with Candida CLABSI incidence in NICUs are lacking.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n We analyzed Candida CLABSIs reported through the Centers for Disease Control and Prevention\u2019s National Healthcare Surveillance Network (NHSN) bloodstream infection module and assessed facility characteristics using NHSN and American Hospital Association annual surveys during 2015-2022. We assessed annual Candida CLABSI incidence\/1000 central line days and fit negative binomial models to assess associations of hospital and NICU characteristics with CLABSI incidence, controlling for birthweight category and year.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Among 862 NICUs, facilities with lower nurse-to-bed ratios (incidence rate ratio [IRR]\u2009=\u20091.33; 95% CI, 1.03\u20131.70) and fewer infection preventionist surveillance hours\/bed (IRR\u2009=\u20091.33; 95% CI, 1.05\u20131.70) had increased Candida CLABSI incidence. Incidence was also higher in the NICUs in the lowest tertile of NICU bed size (IRR\u2009=\u20091.90; 95% CI, 1.42\u20132.53), annual neonatal admissions (IRR\u2009=\u20091.87; 95% CI, 1.21\u20132.79), and percentage of very low birthweight admissions (IRR\u2009=\u20092.12; 95% CI, 1.45\u20133.05) compared with NICUs in the highest tertile of each variable.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n Higher Candida CLABSI rates were observed at smaller NICUs and those with lower staffing ratios, possibly reflecting lower capacity for infection prevention and control and care for neonates who are at high-risk for CLABSIs. These data may inform facility-focused or systems-level interventions to reduce Candida CLABSIs and protect vulnerable neonates.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/hpeds.2025-008803","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:02:51Z","timestamp":1769126571000},"page":"e132-e136","source":"Crossref","is-referenced-by-count":1,"title":["Facility Factors Associated With\n Candida<\/i>\n Central Line\u2013Associated Bloodstream Infections in Neonatal Intensive Care Units"],"prefix":"10.1542","volume":"16","author":[{"given":"Ian","family":"Hennessee","sequence":"first","affiliation":[{"name":"1Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dallas J.","family":"Smith","sequence":"additional","affiliation":[{"name":"1Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin","family":"Benedict","sequence":"additional","affiliation":[{"name":"1Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee M.","family":"Calanan","sequence":"additional","affiliation":[{"name":"2Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmond F.","family":"Maes","sequence":"additional","affiliation":[{"name":"3Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Lyman","sequence":"additional","affiliation":[{"name":"1Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"issue":"1","key":"2026040806565791700_r1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1017\/ice.2019.297","article-title":"Antimicrobial-resistant pathogens associated with pediatric healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015\u20132017","volume":"41","author":"Weiner-Lastinger","year":"2020","journal-title":"Infect Control Hosp Epidemiol."},{"issue":"10","key":"2026040806565791700_r2","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.3201\/eid2910.230181","article-title":"Candida auris clinical isolates associated with outbreak in neonatal unit of tertiary academic hospital, South Africa","volume":"29","author":"Kekana","year":"2023","journal-title":"Emerg Infect Dis."},{"issue":"Suppl)(suppl 1","key":"2026040806565791700_r3","doi-asserted-by":"crossref","first-page":"3007","DOI":"10.1111\/1475-6773.12762","article-title":"Nursing care disparities in neonatal intensive care units","volume":"53","author":"Lake","year":"2018","journal-title":"Health Serv Res."},{"issue":"3","key":"2026040806565791700_r4","doi-asserted-by":"crossref","first-page":"e407","DOI":"10.1542\/peds.2007-0910","article-title":"Black\/white differences in very low birth weight neonatal mortality rates among New York City hospitals","volume":"121","author":"Howell","year":"2008","journal-title":"Pediatrics."},{"issue":"5","key":"2026040806565791700_r5","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1542\/peds.109.5.745","article-title":"Mortality in low birth weight infants according to level of neonatal care at hospital of birth","volume":"109","author":"Cifuentes","year":"2002","journal-title":"Pediatrics."},{"issue":"4","key":"2026040806565791700_r6","doi-asserted-by":"crossref","first-page":"151409","DOI":"10.1016\/j.semperi.2021.151409","article-title":"Access to risk-appropriate hospital care and disparities in neonatal outcomes in racial\/ethnic groups and rural-urban populations","volume":"45","author":"Lorch","year":"2021","journal-title":"Semin Perinatol."},{"issue":"1","key":"2026040806565791700_r7","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/2047-2994-2-11","article-title":"The impact of staffing on central venous catheter-associated bloodstream infections in preterm neonates - results of nation-wide cohort study in Germany","volume":"2","author":"Leistner","year":"2013","journal-title":"Antimicrob Resist Infect Control."},{"issue":"1","key":"2026040806565791700_r8","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1093\/cid\/ciu239","article-title":"Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis","volume":"59","author":"Blot","year":"2014","journal-title":"Clin Infect Dis."},{"key":"2026040806565791700_r9","doi-asserted-by":"crossref","first-page":"103531","DOI":"10.1016\/j.ijnurstu.2020.103531","article-title":"Nurse staffing and healthcare-associated infections in a national healthcare system that implemented a nurse staffing directive: multi-level interrupted time series analyses","volume":"104","author":"Van","year":"2020","journal-title":"Int J Nurs Stud."},{"issue":"26","key":"2026040806565791700_r10","doi-asserted-by":"crossref","first-page":"2454","DOI":"10.1056\/NEJMp2202662","article-title":"Policy strategies for addressing current threats to the U.S. nursing workforce","volume":"386","author":"Costa","year":"2022","journal-title":"N Engl J Med."},{"issue":"3","key":"2026040806565791700_r11","doi-asserted-by":"crossref","first-page":"e2021054955","DOI":"10.1542\/peds.2021-054955","article-title":"Trends of racial\/ethnic disparities in pediatric central line-associated bloodstream infections","volume":"150","author":"Willer","year":"2022","journal-title":"Pediatrics."},{"issue":"8","key":"2026040806565791700_r12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6808a1","article-title":"Population-based active surveillance for culture-confirmed candidemia - 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