Neonatal Invasive Candidiasis in Spain. An epidemiological study from the “Grupo de Hospitales Castrillo”

Abstract

Introduction: Invasive fungal infections, especially Candidemia have emerged as an increasing problem among high risk neonates because of their immature host defenses, frequent exposure to invasive diagnostic and therapeutic procedures, and prolonged hospital stay. Objective: to assess the epidemiology of neonatal invasive candidiasis in our country (Spain). Patients and methods: The data of neonatal invasive candidiasis (NIC) were obtained from a prospective multicenter epidemiological study of nosocomial neonatal sepsis in VLBW infants (birth weight Results: In a total of 7,101 admissions to the neonatal units of the participating hospitals, 2,152 nosocomial sepsis were reported (30.3%), 195 of them were candidemias (2.75%). The incidence of candidemia was significantly higher in tertiary care (referral) hospitals as compared with non-referral hospitals (4.26% vs 1.03%). In relation to the etiology of nosocomial sepsis, Candida spp was the third more frequently isolated pathogen (9.0%) after S. epidermidis (49.8%) and Klebsiella (11.0%). In 96% of infants with candidemia 4 or more risk factors were reported. C. parapsilosis was the pathogen most frequently recovered (42%) followed by C. albicans (38.5%), C. tropicalis (6.15%) and C. glabrata (4.6%). The most frequently antifungal treatment used was liposomal amphotericin B (76.8% of cases) followed of fluconazol (11%). In five infants treatment was not started. The average treatment length was 18 days (range 1-59). Overall mortality rate was 24.1 % and was higher the mortality associated to C. albicans and C. tropicalis (33.0%) compared to C. parapsilosis (17.5%). Prophylactic fluconazol was not used in any hospital. Any isolated Candida species showed resistance to amphotericin B, 3.9% to 5-fluocytosine and 0.9% to fluconazol. Conclusions: Candida spp is a frequently isolated pathogen in nosocomial neonatal sepsis and with a high associated mortality. C. parapsilosis is the most frequently isolated species in our country. All isolated Candida species were sensitive to amphotericin B.