Invasive candidiasis in a Brazilian neonatal intensive care unit

Henrique Yuji Watanabe Silva,Felipe Teixeira De Mello Freitas

doi:10.1590/1806-93042021000200011

Abstract

Abstract Objectives: to describe the epidemiology of invasive candidiasis in a neonatal intensive care unit. Methods: cross-sectional study that included all neonates with invasive candidiasis confirmed by blood culture from April 2015 to June 2018. Demographic, clinical and microbiological data were analyzed, comparing neonates with extreme low birth weight (ELBW) with neonates ≥ 1000g birth weight, considering a p <0.05 as statistically significant. Results: there were 38 cases of invasive candidiasis, resulting in an overall incidence of 2.5%. Twelve (32%) were ELBW neonates and 26 (68%) neonates ≥ 1000g birth weight, an incidence of 4.4% and 2.0%, respectively. Abdominal surgery was more frequent among neonates with birth weight ≥ 1000g compared to ELBW neonates (85% vs. 17%; p <0.01), as well as the median in days of antibiotics use (18 vs. 10.5; p = 0.04). The median in days of mechanical ventilation was more frequent among ELBW neonates (10 vs. 5.5; p = 0.04). The majority of Candida species were non-albicans (64%). Fatality rate was 32%. Conclusions: the incidence of invasive candidiasis among neonates with birth weight ≥ 1000g was higher than that found in the literature. This group has a higher proportion of gastrointestinal malformations that require surgery. Thus, fluconazole prophylaxis may be necessary for a broader group of neonates.

Highlights

Invasive candidiasis is an important cause of morbidity and mortality among neonates admitted to the Neonatal Intensive Care Unit (NICU)
We identified 38 cases of invasive candidiasis, 12 (32%) cases among extreme low birth weight (ELBW) neonates and 26 (68%) among neonates with birth weight ≥1000g, resulting in an overall incidence of 2.5%, 4.4% among neonates of ELBW and 2.0% among those with birth weight ≥1000g
We found a fatality rate of 32%, similar to the 34% found in a prospective cohort of ELBW neonates, which took place over three years at 19 centers in the United States.[1]

Summary

Introduction

Invasive candidiasis is an important cause of morbidity and mortality among neonates admitted to the Neonatal Intensive Care Unit (NICU). Risk factors associated with invasive candidiasis include prematurity, very low birth weight, vascular catheters, parenteral nutrition, administration of broad-spectrum antibiotics, abdominal surgery, prolonged hospitalization, and artificial ventilation.[13]. Different strategies have been developed to prevent and improve outcomes related to invasive candidiasis among ELBW neonates. The two main strategies are 1) empiric antifungal therapy, which has reduced Candida associated mortality,[6-8] and 2) fluconazole prophylaxis, which has had an impact in reducing the incidence of invasive candidiasis with no adverse outcomes as fluconazole toxicity or emergence of resistant Candida species.[9,10]. We decided to study invasive candidiasis from a tertiary NICU, a referral center for neonatal surgery and preterm birth, located in Brasilia, Brazil, during a period that fluconazole prophylaxis was not implemented, comparing ELBW neonates and neonates with birthweight ≥1000g, in order to support our decision to begin fluconazole prophylaxis or not The reported incidence in neonates with birth weight >1500g is below 1%.11 we decided to study invasive candidiasis from a tertiary NICU, a referral center for neonatal surgery and preterm birth, located in Brasilia, Brazil, during a period that fluconazole prophylaxis was not implemented, comparing ELBW neonates and neonates with birthweight ≥1000g, in order to support our decision to begin fluconazole prophylaxis or not

Objectives

Methods

Results

Conclusion