Retrospective analysis of 76 neonates with invasive fungal infection in 2004-2014

Abstract

Objective To investigate the clinical features of neonatal invasive fungal infection(IFI)so as to guide diagnosis, prevention and treatment of IFI. Methods Seventy-six neonates with IFI admitted to the Neonatal Intensive Care Unit (NICU) at Children's Hospital of Fudan University from 2004 to 2014 were included in the study. Pathogens, clinical manifestation, risk factor exposure, laboratory findings, complications, and clinical outcome of neonatal IFI were analyzed. Results Seventy-six cases were diagnosed as IFI between 2004 and 2014, with an yearly increasing trend. Sixty-eight patients were premature infants (89.5%). Of the 76 cases, except one with unknown birth weight, 11(14.7%), 34(45.3%), 20(26.7%)and 10 (13.3%) cases had birth weight < 1 000 g, (≥1 000-<1 500) g, (≥1 500-<2 500) g and ≥2 500 g, respectively. The pathogens were mainly Candida (74/76, 97.4%), including 26 cases of Candida albicans (34.2%). However, the incidence of non-Candida albicans infection was increasing. Candida guilliermondii was the most common in non-Candida albicans, accounting for 29.2% (14/48). All Candida albicans were sensitive to fluconazole. One strain of Candida glabrata was resistant to fluconazole. The most common risk factors included use of broad-spectrum antibiotics(93.3%, 56/60), parenteral nutrition(70.0%, 42/60), central vein catheterization(53.3%, 32/60), invasive ventilation(40.0%, 24/60) and history of abdominal surgery(21.7%,13/60). Clinical manifestations of IFI included temperature instability, frequent apnea, increased requirement of respiratory support and feeding intolerance. Among all cases, six were diagnosed as central nervous system infection. Of the patients who received cranial MRI, 46.8%(22/47) showed multiple abnormal signals in cerebral parenchyma. Fifty-two patients were cured and seven patients died before discharge, including one death due to fungal infection. Conclusions There is an increasing trend of IFI cases in NICU, especially in premature infants. Non-Candida albicans has become the main pathogenic fungus. There are no specific clinical manifestations in neonatal IFI. Use of broad-spectrum antibiotics, parenteral nutrition and central venous catheterization are common risk factors, and preventive measures should be taken in high-risk infants. In addition, IFI in neonates may affect important organs such as central nervous system, thus early treatment is necessary in suspected patients. Key words: Candidiasis, invasive; Intensive care units, neonatal; Retrospective studies