Candidemia in Brazilian neonatal intensive care units: risk factors, epidemiology, and antifungal resistance

Silva, Carolina Maria da; Carvalho, Ana Maria Rabelo de; Macêdo, Danielle Patrícia Cerqueira; Jucá, Moacir Batista; Amorim, Rosemary de Jesus Machado; Neves, Rejane Pereira

doi:10.1007/s42770-023-00943-1

Cited by 13 publications

(6 citation statements)

References 48 publications

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“…BW and GA are important risk factors [15,23]. Other major risk factors include exposure to broad-spectrum antibiotics, the duration of parenteral nutrition, use of fat emulsions, prolonged artificial ventilation, immunodepression, fungal colonization, application of CVC and ICU admission [12,[24][25][26]. In our study, the percentage of IFI infants with endotracheal intubation, CVC, invasive procedures and the use of broad-spectrum antibiotics was high, which is consistent with the results of above studies.…”

Section: Discussionsupporting

confidence: 91%

End-organ damage from neonatal invasive fungal infection: a 14-year retrospective study from a tertiary center in China

Han,

Qiu,

Niu

et al. 2024

BMC Infect Dis

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Background Invasive fungal infection (IFI) has become an increasing problem in NICU neonates, and end-organ damage (EOD) from IFI is one of the leading causes of morbidity and mortality in neonates. This study was conducted to summarize clinical data on epidemiology, risk factors, causative pathogens, and clinical outcomes of IFI-associated EOD among neonates in a center in China for the sake of providing references for prevention and treatment of fungal infections in neonates in future. Methods The clinical data of IFI neonates who received treatment in a tertiary NICU of China from January 2009 to December 2022 were retrospectively analyzed, including causative pathogens and the incidence of EOD. The neonates were divided into EOD group and non-EOD (NEOD) group. The general characteristics, risk factors and clinical outcomes of the two groups were compared. Results Included in this study were 223 IFI neonates (137 male and 86 female) with a median gestational age (GA) of 30.71 (29,35) weeks and a median birth weight (BW) of 1470 (1120,2150) g. Of them, 79.4% were preterm infants and 50.2% were born at a GA of ≥ 28, <32 weeks, and 37.7% with BW of 1000–1499 g. Candida albicans (C. albicans) was the most common Candida spp. in these neonates, accounting for 41.3% of all cases, followed by C. parapsilosis (30.5%) and C. glabrata (7.2%). EOD occurred in 40 (17.9%) of the 223 cases. Fungal meningitis was the most common EOD, accounting for 13.5% of the 40 EOD cases. There was no significant difference in the premature birth rate, delivery mode, GA and BW between EOD and NEOD groups, but the proportion of male infants with EOD was higher than that without. There was no significant difference in antenatal corticosteroid use, endotracheal intubation, invasive procedures, use of antibiotics, total parenteral nutrition, blood transfusion, postnatal corticosteroid use, fungal prophylaxis and the incidence of necrotizing enterocolitis between the two groups, but the proportion of C. albicans infection cases in EOD group was higher than that in NEOD group (57.5% vs. 37.7%). Compared with NEOD group, the proportion of cured or improved infants in EOD group was significantly lower (P < 0.05), and the number of infants who died or withdrew from treatment was larger (P < 0.05). Conclusions Our retrospective study showed that preterm infants were prone to fungal infection, especially very preterm infants. C. albicans was the most common Candida spp. for IFI, and was a high-risk factor for EOD. EOD can occur in both full-term and premature infants, so the possibility of EOD should be considered in all infants with IFI.

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Section: Discussionsupporting

confidence: 91%

End-organ damage from neonatal invasive fungal infection: a 14-year retrospective study from a tertiary center in China

Han,

Qiu,

Niu

et al. 2024

BMC Infect Dis

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“…In developed countries, it is a rarer cause of late-onset sepsis (LOS) among neonates compared to low- and middle-income countries. Candida prevalence in LOS varies from 1.9% in European countries [20,21] to 5.1% in United States [22 ▪ ] and can be as high as 6.3% in Argentina [26]and 11% in Brazil, with high mortality [25,27 ▪ ,28 ▪ ] (Table 2). It is believed that the higher incidence of Candida spp.…”

Section: Candida Spp Infectionsmentioning

confidence: 99%

“…Invasive fungal infection (IFI) is a major complication in immunocompromised adults [1–3] and children, including critically ill neonates [4 ▪▪ ,5] and children with haematologic diseases and recipients of allogeneic hematopoietic stem-cell transplantation (HSCT) [6,7]. Endemic mycosis (EM) used to be present in specific areas of known endemicity but there have been increasing reports of EM in areas previously considered nonendemic [8].…”

Section: Introductionmentioning

confidence: 99%

Overview of invasive fungal infections in children in South America – the threat of resistant Candida species and the role of climate change in the new geographic distribution of endemic systemic mycosis

Fonseca

2024

Current Opinion in Pediatrics

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Purpose of review Invasive fungal infection (IFI) in children is a growing problem with crescent morbidity and mortality, well recognized in developed countries, affecting mainly immunocompromised children, including neonates and children in intensive care units. The burden of IFI in South American children is less well comprehended. In addition, the current epidemiology of endemic systemic mycoses in children may have changed over time. Recent findings Candida spp. infections are very prevalent in South America hospitalized children, especially in neonates, in a rate far superior compared to developed countries. C. auris, has already been responsible for outbreaks in neonates and children in Venezuela and Colombia. Sporotrichosis is well established as an urban zoonosis in impoverish families. Paracoccidioidomycosis and histoplasmosis are affecting new areas of Brazil, probably due to climate change, deforestation, and human migration. Summary This review aims to unveil the real dimension of these infections in South American children. Hopefully, the awareness brought by this review will help healthcare professionals to recognize IFI more easily and it will provide support for getting more resources for IFI treatment and prevention.

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“…A tool to overcome those limitations is protein engineering strategies, because the chemical synthesis of AFPs is expensive at large scale, and purification in natural sources does not fulfill the market needs. Rational design is based on knowledge of a peptide’s structure or function, which can improve antifungal activity and proteolytic and thermal stability [ 79 ], by introducing enantiomeric peptides and substitutions by amidated bridges [ 126 , 127 ]. Other ways of protecting the AMPs involve modifications in the N- and C-terminal portions, as well as cyclic forms aiming to increase the stability of the peptides against physiological salt concentrations and the possibility of degradation by proteases [ 128 – 130 ].…”

Section: Antimicrobial Peptides (Amps)mentioning

confidence: 99%

Candida albicans and Antifungal Peptides

Freitas,

Felipe

2023

Infect Dis Ther

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Candida albicans , a ubiquitous opportunistic fungal pathogen, plays a pivotal role in human health and disease. As a commensal organism, it normally resides harmlessly within the human microbiota. However, under certain conditions, C. albicans can transition into a pathogenic state, leading to various infections collectively known as candidiasis. With the increasing prevalence of immunocompromised individuals and the widespread use of invasive medical procedures, candidiasis has become a significant public health concern. The emergence of drug-resistant strains further complicates treatment options, highlighting the urgent need for alternative therapeutic strategies. Antifungal peptides (AFPs) have gained considerable attention as potential candidates for combating Candida spp. infections. These naturally occurring peptides possess broad-spectrum antimicrobial activity, including specific efficacy against C. albicans . AFPs exhibit several advantageous properties, such as rapid killing kinetics, low propensity for resistance development, and diverse mechanisms of action, making them promising alternatives to conventional antifungal agents. In recent years, extensive research has focused on discovering and developing novel AFPs with improved efficacy and selectivity against Candida species. Advances in biotechnology and synthetic peptide design have enabled the modification and optimization of natural peptides, enhancing their stability, bioavailability, and therapeutic potential. Nevertheless, several challenges must be addressed before AFPs can be widely implemented in clinical practice. These include optimizing peptide stability, enhancing delivery methods, overcoming potential toxicity concerns, and conducting comprehensive preclinical and clinical studies. This commentary presents a short overview of candidemia and AFP; articles and reviews published in the last 10 years were searched on The National Library of Medicine (National Center for Biotechnology Information–NIH–PubMed). The terms used were C. albicans infections, antimicrobial peptides, antifungal peptides, antifungal peptides mechanisms of action, candidemia treatments and guidelines, synthetic peptides and their challenges, and antimicrobial peptides in clinical trials as the main ones. Older publications were cited if they brought some relevant concept or helped to bring a perspective into our narrative. Articles older than 20 years and those that appeared in PubMed but did not match our goal to bring updated information about using antifungal peptides as an alternative to C. albicans infections were not considered.

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Candidemia in Brazilian neonatal intensive care units: risk factors, epidemiology, and antifungal resistance

Cited by 13 publications

References 48 publications

End-organ damage from neonatal invasive fungal infection: a 14-year retrospective study from a tertiary center in China

End-organ damage from neonatal invasive fungal infection: a 14-year retrospective study from a tertiary center in China

Overview of invasive fungal infections in children in South America – the threat of resistant Candida species and the role of climate change in the new geographic distribution of endemic systemic mycosis

Candida albicans and Antifungal Peptides

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