Invasive Candida Infections in Neonates after Major Surgery: Current Evidence and New Directions.

Domenico Umberto De Rose ,Paolo Manzoni,Lisa Serafini,Andrea Dotta,Chryssoula Tzialla,Lorenza Pugni,Ilaria Cocchi,Cinzia Auriti,Pasqua Betta,Alessandra Santisi,Jenny Bua,Giovanna Nardella,Benedetta Della Torre,Francesco Cavigioli,Elvira Bonanno,Ludovica Martini,Pietro Bagolan,Danila Mazzeo,Marzia Maino,Mario Giuffrè ,Maria Paola Ronchetti

doi:10.3390/pathogens10030319

Abstract

Infections represent a serious health problem in neonates. Invasive Candida infections (ICIs) are still a leading cause of mortality and morbidity in neonatal intensive care units (NICUs). Infants hospitalized in NICUs are at high risk of ICIs, because of several risk factors: broad spectrum antibiotic treatments, central catheters and other invasive devices, fungal colonization, and impaired immune responses. In this review we summarize 19 published studies which provide the prevalence of previous surgery in neonates with invasive Candida infections. We also provide an overview of risk factors for ICIs after major surgery, fungal colonization, and innate defense mechanisms against fungi, as well as the roles of different Candida spp., the epidemiology and costs of ICIs, diagnosis of ICIs, and antifungal prophylaxis and treatment.

Highlights

Yeasts are commensal microorganisms that usually colonize mucosal surfaces and skin
We provided an overview of risk factors for ICIs after major surgery, the innate defense mechanisms against fungi, the role of different Candida spp., the epidemiology and costs of ICIs, and the antifungal prophylaxis
Infants requiring surgery carry many risk factors for candidemia and are likely to benefit from antifungal prophylaxis

Summary

Introduction

Yeasts are commensal microorganisms that usually colonize mucosal surfaces and skin. In particular clinical conditions, such as immune suppression, prolonged use of broadspectrum antibiotics and/or steroids, the balance of the colonizing flora of the skin is altered and fungi express numerous factors that contribute to pathogenicity. Invasive fungal infections (IFIs) in neonatal intensive care units (NICUs) are a substantial health problem, as they are the second most common cause of infection-related death among critically ill neonates. Ill patients in NICUs (and in particular preterm neonates) are at high risk of IFIs, especially if they need broad-spectrum antibiotic treatments, surgery that disrupts natural defense barriers, intravascular catheters for prolonged periods, or implantation of invasive devices to survive. Their immunological impairments are predisposed to fungal colonization and to subsequent systemic infection. Bloodstream infections due to the Candida species (C. spp.) are considered the most common IFIs in critically ill patients in NICUs

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