Abstract
Fungal infections are an important cause of morbidity and mortality in neonatal intensive care units (NICUs). The identifi-cation of specific risk factors supports pre-vention of candidemia in neonates. Effec-tive prophylactic strategies have recently become available, but the identification and adequate management of high-risk in-fants is still a priority. Prior colonization is a key risk factor for candidemia. For this reason, surveillance studies to monitor in-cidence, species distribution, and antifun-gal susceptibility profiles, are mandatory. Among 520 infants admitted to our NICU between January 2013 and December 2014, 472 (90.77%) were included in the study. Forty-eight out of 472 (10.17%) pa-tients tested positive for Candida spp. (C.), at least on one occasion. All the colonized patients tested positive for the rectal swab, whereas 7 patients also tested positive for the nasal swab. Fifteen out of 472 patients (3.18%) had more than one positive rec-tal or nasal swab during their NICU stay. Moreover, 9 out of 15 patients tested nega-tive at the first sampling, suggesting they acquired Candida spp. during their stay. Twenty-five of forty-eight (52.1%) colo-nized patients carried C.albicans and 15/48 (31.25%) C.parapsilosis. We identified as risk factors for Candida spp. colonization: antibiotic therapy, parenteral nutrition, the use of a central venous catheter, and nasogastric tube. Our experience suggests that effective microbiological surveillance can allow for implementing proper, effec-tive and timely control measures in a high-risk setting.
Highlights
Fungal infections are an important cause of increased morbidity and mortality in infants admitted to neonatal intensive care units (NICUs)
In very low birth weight (VLBW) infants Candida (C.) albicans is the third most common cause of neonatal late onset sepsis (LOS). [1] The overall incidence of candidemia in NICUs is increasing because of longer survival and more invasive procedures related with the intensive care of extremely preterm infants
The results of this study clearly suggest that effective microbiological surveillance can help maintain the quality of care provided
Summary
Fungal infections are an important cause of increased morbidity and mortality in infants admitted to neonatal intensive care units (NICUs). In very low birth weight (VLBW) infants Candida (C.) albicans is the third most common cause of neonatal late onset sepsis (LOS). [2] Many factors account for the high risk of systemic fungal infections (SFI) in preterm infants in the NICU. They include: prior antibiotic exposure, hyper alimentation, use of intravenous fat emulsions and endotracheal intubation. Prevention of candidemia in neonates is supported by identification and adequate management of specific risk factors, including low birth weight, use of invasive devices, prolonged hospitalization and use of broad-spectrum antimicrobial agents. Previous experience with the circulation of pathogenic microorganisms in the NICU, suggests that for fungi it is mandatory to conduct surveillance studies to monitor incidence, species distribution, and antifungal susceptibility profiles. [12] To assess the epidemiology of Candida spp. colonization in hospitalized neonates in our setting, we performed a prospective cohort study at the tertiary NICU of the University Hospital ‘‘Paolo Giaccone’’, Palermo, Italy
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