Neonatal Candida Infections Research Articles

A Decade of Invasive Candida Infection in Neonates: A Retrospective Study at a Tertiary Neonatal Intensive Care Unit in Thailand (2008–2018)

A Decade of Invasive Candida Infection in Neonates: A Retrospective Study at a Tertiary Neonatal Intensive Care Unit in Thailand (2008–2018)

Optimisation of fluconazole therapy for the treatment of invasive candidiasis in preterm infants

IntroductionFluconazole is an important antifungal in the prevention and treatment of invasive Candida infections in neonates, even though its use in preterm infants is still off-label. Here, we performed a...

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

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.

Health care-associated invasive Candida infections in children.

The aims of the study were to examine the distribution of Candida spp. isolated from sterile body sites, the antifungal susceptibility of the isolates to amphotericin B, and fluconazole, risk factors and clinical outcomes associated with invasive health care-associated Candida infections in neonates and children. Between January 2007 and January 2012, the patients with invasive candidiasis were detected from microbiology laboratary records and medical records were examined retrospectively. Candida spp. were isolated from sterile body sites in 94 patients. The most common underlying diseases were prematurity in neonates and surgery in children. Parenteral nutrition, stay in intensive care unit (ICU), and mechanical ventilation (MV) were major risk factors in neonates. Hospitalization before infection and immunosuppressant therapy were significantly more frequent in children. Of Candida infection episodes, 29.8% was due to C. albicans and 70.2% was due to non-albicans Candida spp. The most common isolated species was C. parapsilosis. Of the Candida species, 90.8% were sensitive, and 9.2% were resistant to fluconazole. The rate of amphotericin B resistant was 1.3%; 23.4% of the patients died in the first 30 days. The main variables associated with mortality were neonates, prematurity, stay in the ICU, parenteral nutrition, MV, length of stay, amphotericin B susceptibility, and high levels of C-reactive protein.

Randomized Pharmacokinetic Study of Fluconazole and Micafungin in Preterm Neonates with Suspected or Proven Fungal Infection

Introduction: Neonatal Candida infection requires urgent treatment because of high risk disease with possible central nervous system infection. Fluconazole prophylaxis is recommended in NICUs with a high incidence in fungal infections. Both fluconazole and micafungin are used for treatment in preterm and term neonates with proven or only suspected fungal infection, as candida infection is difficult to prove. Although fluconazole dose recommended in the marketing authorization is 6 mg/kg/day in neonates, maintenance doses currently used in NICUs in Europe is often higher, between 6 and 12 mg/kg. For Micafungin, the available data support the idea that only dosages greater than recommended (2 to 4 mg/kg/day) may ensure adequate coverage of the CNS. The drug-exposure target recommended for fluconazole is at least 400 mg*h/L and for micafungin is at least 166.5 mg*h/L. In this context, the current study is designed to further elucidate the pharmacokinetics of the two drugs in preterm neonates.

Successful Treatment of an Infant Infected with Refractory C. parapsilosis with Caspofungin

Neonatal Candida infections are the leading cause of invasive fungal infections that might cause severe morbidity or mortality in a large majority of those affected. Although Candida albicans has been the most common species, Candida parapsilosis is increasingly being recognized as an important cause of invasive candidiasis in neonates. Among the Candida species, C. parapsilosis has been commonly isolated and shown to be less susceptible in vitro to echinocandins than other Candida species. We report an infant who had refractory C. parapsilosis septicemia cured with caspofungin.

Candida parapsilosis Is a Significant Neonatal Pathogen

Candida is the third most common cause of late-onset neonatal sepsis in infants born at <1500 g. Candida parapsilosis infections are increasingly reported in preterm neonates in association with indwelling catheters. We systematically reviewed neonatal literature and synthesized data pertaining to percentage of C. parapsilosis infections and mortality by meta-analyses. We also reviewed risk factors, virulence determinants, antimicrobial susceptibility patterns and outlined clinical management strategies. C. parapsilosis infections comprised 33.47% (95% confidence interval [CI]: 30.02, 37.31) of all neonatal Candida infections. C. parapsilosis rates were similar in studies performed before the year 2000, 33.53% (95% CI: 30.06, 37.40) (28 studies), to those after 2000, 27.00% (95% CI: 8.25, 88.37) (8 studies). The mortality due to neonatal C. parapsilosis infections was 10.02% (95% CI: 7.66, 13.12). Geographical variations in C. parapsilosis infections included a low incidence in Europe and higher incidence in North America and Australia. Biofilm formation was a significant virulence determinant and predominant risk factors for C. parapsilosis infections were prematurity, prior colonization and catheterization. Amphotericin B remains the antifungal drug of choice and combination therapy with caspofungin or other echinocandins may be considered in resistant cases. C. parapsilosis is a significant neonatal pathogen, comprises a third of all Candida infections and is associated with 10% mortality. Availability of tools for genetic manipulation of this organism will identify virulence determinants and organism characteristics that may explain predilection for preterm neonates. Strategies to prevent horizontal transmission in the neonatal unit are paramount in decreasing infection rates.

PP-141. Neonatal candida infections and antifungal susceptibility testing

PP-141. Neonatal candida infections and antifungal susceptibility testing

Empiric guidelines for treatment of Candida infection in high-risk neonates

The incidence of neonatal Candida infection is steadily increasing and has been reported to be 1.6% in infants admitted to neonatal intensive care units (NICUs) [3].The use of therapeutic guidelines based on risk factors for fungal infection is important for achieving an early diagnosis of invasive Candida infection and for obtaining a decrease of its morbidity and mortality [1]. We performed this study in order to evaluate the efficacy of empiric guidelines in reducing proven mortality resulting from Candida infection.

Seasonality of Invasive Candida Infection in Neonates

Seasonality of Invasive Candida Infection in Neonates

Neonatal candida infection of the CNS : A case report

Neonatal candida infection of the CNS : A case report

Candida endocarditis in neonates: report of five cases and review of the literature

Candidal endocarditis is an uncommon and serious complication of invasive Candida infection in neonates. The aim of this study was to further characterise candidal endocarditis in neonates. Between 1995 and 2000, 56 patients were diagnosed with Candida bloodstream infections (CBSI) in the Neonatal Intensive Care Unit of Schneider Children's Medical Center of Israel. Five of them (9%) developed mycetoma of the right atrium. None of the patients had congenital heart disease or a central venous catheter in the right heart at the time of diagnosis. All were treated with amphotericin B alone or in combination with other antifungals, without surgical intervention. One patient died of the disease and one died later of polymicrobial sepsis and necrotizing enterocolitis. A review of the literature since 1980 yielded an additional 25 cases of candidal endocarditis. For the whole sample (n = 30) survival rate was 73.1%. Six of the 10 patients treated with antifungal agents and surgery survived (60%), compared with 13 of the 20 patients treated only medically (65%) (P = 1.0). Candida endocarditis in neonates differs from fungal endocarditis in adults in risk factors, clinical presentation and outcome. As the outcome of surgical and medical treatment are comparable, antifungal therapy alone may be a valid therapeutic option in high-risk cases.

25 Reduced Neonatal Candida Infection as a Result of Medical Practice Intervention

Objective: To assess the impact of a medical practice intervention on the incidence of Candida spp. sepsis among neonates with a birth weight ofH 750 grams admitted to a level 3 neonatal intensive care unit (NICU). Methods: In July 1996 implementation of medical practice included;(1) administration of oral nystatin (every 6 hours for the first week of life and with each antibiotic course during the first four weeks of life). (2) Modifying parameters for extubation, (3) Early discontinuation of central lines (UAC, UVC, PCVC, CL), (4) Parenteral nutrition (PN) and antibiotics. We reviewed charts and collected data from January 1, 1995 to December 31, 1998. Neonates who died atH 3days of age or were admitted atG 7days of age were excluded. The intervention group consisted of 69 neonates, admitted between July 1, 1996 and December 31, 1998 and the control group consisted of 45 neonates, admitted between January 1, 1995 and June 30, 1996. We measured the outcome by using student t test and standard logistic regression techniques. The above management plan was continued after the study period. Retrospective analysis of the incidence of Candida infection in NICU was followed for 1999 to 2004. Results: The intervention group experienced fewer episodes of Candida spp. sepsis, OR 0.07 (p=<0.0002) adjusting for gestational age, mode of delivery and number of days of central vascular access. The estimated gestational age was longer (EGA) (24.9 vs. 24.4 p=<0.05) and more neonates received feedings (93% vs. 73%, p=<0.05). Within the intervention group, exposure to high humidity environment was associated with a higher risk of Candida spp. sepsis, OR 10.5 (p<0.06). The incidence of candida spp. During 1999 to 2004 remained between 0% to 3%. Conclusion: Oral nystatin administration substantially reduced the risk of Candida spp. sepsis among neonates with birth weightH 750g, while vaginal delivery was an independent risk factor. High humidity environment may be an additional risk factor for developing Candida spp. sepsis. Table 1

Seasonality of invasive Candida infection in neonates

To evaluate season of birth as a risk factor for the development of invasive Candida in our population of preterm low-birthweight infants. Retrospective identification of Candida-positive blood or cerebrospinal fluid (CSF) cultures in infants < 32 wk over an 8-y period. There were 1400 admissions of infants < 32 wk gestation, of whom 52 (3.7%) developed invasive Candida infection. Thirty-eight of 52 (73%) occurred during the months September to February. It may be appropriate to consider seasonal associations when targeting selective antifungal chemoprophylaxis.

Seasonality of invasive Candida infection in neonates

Seasonality of invasive Candida infection in neonates

Candidal renal and urinary tract infection in neonates

Candida species are a common cause of urinary tract infection in newborns requiring intensive care. Renal candidiasis is frequently associated with these urinary tract infections and is manifest by “fungus balls” or renal parenchymal infiltration. Candidal urinary tract infections in high-risk newborns are often associated with candidemia, thereby warranting systemic antifungal therapy. Sonography is useful in diagnosing renal candidiasis, obstruction from “fungus balls,” and abscesses. The sonographic appearance of “fungus balls” may persist long after clinical resolution of Candida infection in neonates and should not affect duration of antifungal therapy. Amphotericin B is currently the drug of choice for neonates with renal candidiasis and candidal urinary tract infection. Surgical management should be reserved for decompression of obstructive candidiasis and drainage of abscesses.

Antifungal pharmacotherapy for neonatal candidiasis

Candida is a leading cause of late onset infection (>3 days of age) in the premature infant. Therefore, decisions about the diagnosis and management of infections caused by Candida are commonplace in the neonatal intensive care unit. Despite this fact, there are few comparative trials about treatment of neonatal Candida infections to guide the practitioner. New antifungals have been developed in the past decade and some clinical experience has been reported that can be used to guide the treatment of infants with serious Candida infections. This article reviews recent pertinent data with regard to dosing guidelines, efficacy, and toxicities of available systemic antifungal agents in the newborn.

Neonatal candidosis: clinical picture, management controversies and consensus, and new therapeutic options.

Candida infections are increasingly being recognized as a major cause of septicaemia in neonatal intensive care units, and are associated with high morbidity (25%) and mortality (25-54%). Low birth weight pre-term infants are especially vulnerable to this devastating disease. The most frequently encountered fungal infections are caused by Candida albicans, Candida parapsilosis and, rarely, by Candida tropicalis. Amphotericin B (with or without flucytosine) is the treatment of choice for Candida infections in neonates. Conventional amphotericin B use is often limited by its severe side effects, although these tend to be fewer in neonates than in adults. Possible alternatives to amphotericin B include triazoles (such as fluconazole) and lipid preparations of amphotericin B. Liposomal encapsulation of amphotericin B has been shown to decrease the toxicity of the drug while maintaining its antifungal activity. The liposomal formulation AmBisome has proved to be effective in the treatment of severe fungal infections in adult and paediatric immunocompromised patients who fail to respond to conventional amphotericin B. The experience with AmBisome in the treatment of fungal infections in neonates is limited, and the drug has been used mainly in infants either failing conventional amphotericin B or having intolerable toxicity. Pharmacokinetic studies have not yet been performed in neonates. Three uncontrolled studies published between 1997 and 1998 on AmBisome (dose range 1-7 mg/kg/day) in the treatment of neonatal candidosis revealed that the drug was effective and safe. New information is accumulating on the safe use of high-dose AmBisome (5-7 mg/kg/day) in very low birth weight infants, and successful use of the drug as first-line therapy of neonatal candidosis. These promising results suggest a potential role for AmBisome as an additional first-line treatment of systemic candidosis in neonates.