Controversies about the management of invasive fungal infections in very low birth weight infants

Moreira, Maria Elizabeth Lopes

doi:10.2223/1300

Cited by 11 publications

(30 citation statements)

References 38 publications

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“…Conforme os fatores de risco descritos anteriormente, esse único paciente com candidemia esteve exposto aos seguintes: peso ao nascimento menor que 1.000 g, IG menor de 30 semanas, colonização prévia por C. albicans em sítio intestinal e oral, PICC, NPT, VM, plaquetopenia, leucopenia e uso de mais de três esquemas antibióticos de amplo espectro. A terapêutica empírica foi iniciada com fluconazol baseada na piora clínica insidiosa, associada à piora dos exames laboratoriais e colonização fúngica prévia, conforme sugere a literatura 7 19,20 . A soma desses fatores pode ter retardado o início da terapêutica antifúngica e alterado o prognóstico do recém-nato.…”

Section: Discussionunclassified

“…Influenciam nessa prevalência, tanto a complexidade dos pacientes quanto a adoção de medidas de prevenção, controle dos fatores de risco durante o atendimento hospitalar e a experiência do serviço em questão. A instituição da profilaxia com antifúngicos nos RNs sob exposição a um grande número de fatores de risco (a exemplo do único RN que teve candidemia) deve levar em conta essas particularidades, merecendo uma discussão cuidadosa, especialmente devido ao ainda controverso embasamento bibliográfico 1,9,19,21 .…”

Section: Discussionunclassified

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Fungal colonization in newborn babies of very low birth weight: a cohort study

Pinhat¹,

Borba²,

Ferreira³

et al. 2012

J Pediatr (Rio J)

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Objectives: To learn about the profile of fungal colonization and related risk factors in premature newborns. Methods:Prospective cohort, from 04/01/2010 to 04/31/2011, with 44 patients admitted to the neonatal intensive care unit, born at the hospital maternity, weighing less than 1,500 g. On admission, data were collected on pre-natal care and childbirth. Clinical and laboratory information, nasal and rectal swabs, and peripheral blood cultures were collected on days 1,7,10 and 14 of stay in neonatal intensive care unit and then, every 7 days until discharge or death. For statistical analysis, we used chi-square test, Fisher exact test, Kaplan-Meier and logistic regression model. Results:The incidence of colonization was 13.5/1,000 patients/ day. The incidence of candidemia was 0.9/1,000 patients/day. The average hospitalization time was 30.5 days (± 20.27), and the onset of colonization occurred, in average, at 11.13 days (±8.82). Vaginal delivery was found to be an independent risk factor for the development of fungal colonization during hospitalization (p = 0.042, odds ratio = 4.38, 95% confidence interval [95%CI] = 1,13-16,99). Likewise, leukocytosis (> 30,000/mm 3 ) on admission was an indicator for the simultaneous presence of fungal colonization (p = 0.048). The presence of bronchopulmonary dysplasia tends to be a factor of higher probability for the development of colonization (p = 0.067). The most affected colonization site was the rectal mucosa: 89.09 versus 10.9% of the nasal mucosa. Conclusion:Vaginal delivery and leukocytosis over 30,000/mm 3 on admission were found to be risk factors for fungal colonization during hospitalization.J Pediatr (Rio J). 2012;88(3):211-6: Candidiasis, candidemia, prematurity, Neonatal Intensive Care Unit. ResumoObjetivos: Conhecer o perfil de colonização fúngica e os fatores de risco associados em recém-nascidos prematuros.Métodos: Coorte prospectiva, de 01/04/10 a 31/04/11, com 44 pacientes admitidos na unidade de terapia intensiva neonatal, nascidos na maternidade do hospital, com peso menor que 1.500 g. Na admissão, coletaram-se dados sobre pré-natal e parto. Informações clínico-laboratoriais, swabs nasal, retal e hemocultura periférica foram coletados nos dias 1, 7, 10 e 14 de permanência na unidade de terapia intensiva neonatal e, então, a cada 7 dias até alta ou óbito. Para análise estatística, utilizou-se teste qui-quadrado, exato de Fisher, curva de Kaplan-Meier e modelo de regressão logística.Resultados: A incidência de colonização foi de 13,5/1.000 pacientes/dia. A de candidemia foi de 0,9/1.000 paciente/dia. A média de internamento foi de 30,5 dias (±20,27), sendo o início da colonização, em média, aos 11,13 dias (±8,82). O parto vaginal foi um fator de risco independente para desenvolvimento de colonização fúngica ao longo da internação [p = 0,042; odds ratio = 4,38; intervalo de confiança de 95% (IC95%) = 1, [13][14][15][16]99]. Da mesma forma, a leucocitose (> 30.000/mm 3 ) na admissão foi um sinalizador para a presença concomitante de colonização...

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Section: Discussionunclassified

Fungal colonization in newborn babies of very low birth weight: a cohort study

Pinhat¹,

Borba²,

Ferreira³

et al. 2012

J Pediatr (Rio J)

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“…No serum concentrations or pharmacokinetic parameters of DAMB were found to be helpful in predicting the efficacy or toxicity of the drug [18]. The test dose in neonates is considered as not necessary as no adverse response to the test dose has ever been reported in infants [19,21,22,23 ].…”

Section: Deoxycholate Amphotericin Bmentioning

confidence: 99%

“…It also affects distal tubular epithelium causing renal tubular acidosis with electrolyte disturbance, notably hypokalaemia [16,51]. Nephrotoxicity is cumulative and may lead to renal failure [22]. Overall, the clinical studies including infants and children showed that amphotericin B is less nephrotoxic in infants and younger children, which may be due to its faster clearance [16].…”

Section: Amphotericin Bmentioning

confidence: 99%

Amphotericin B in neonates: deoxycholate or lipid formulation as first-line therapy – is there a ‘right’ choice?

Turkova

Roilides

2011

Current Opinion in Infectious Diseases

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“…The present results agree with other studies that show C. parapsilosis as the most prevalent species in premature patients. This species provokes exogenous infections, since it colonizes the skin -especially the hands -of healthcare professionals, glycosylated solutions for hospital use, and central venous catheters, being associated with total parenteral nutrition (31).…”

Section: An Increase In Invasive Infections Caused Bymentioning

confidence: 99%

Candidemia in a brazilian tertiary hospital: microbiological and clinical features over a six-year period

Mondelli¹,

Niéro-Melo²,

Bagagli³

et al. 2012

J. Venom. Anim. Toxins incl. Trop. Dis

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Abstract:Yeasts are becoming a common cause of nosocomial fungal infections in immunocompromised patients. Such infections often develop into sepsis with high mortality rates. The aim of this study was to evaluate some of the numerous factors associated with the development of candidemia. Medical records were retrospectively analyzed of 98 Candida spp. patients. Results showed that the most prevalent risk factors for developing candidemia were: antibiotics and antifungal agents (93.9% and 79.6%, respectively); the use of central venous catheter (93.9%); mechanical ventilation (73.5%); and parenteral nutrition (60.2%). The main species of Candida found were: C. parapsilosis (37.76%), C. albicans (33.67%); and others (28.57%). C. glabrata showed the highest mortality rate (75%), followed by C. tropicalis (57.1%) and C. albicans (54.5%). The elevated mortality rate found in this study indicates that preventive measures against candidemia must be emphasized in hospitals.Key words: candidemia, mortality, associated factors, Candida albicans. Original PaPer The Journal of Venomous Animals and Toxins including Tropical Diseases ISSN 1678-9199 | 2012 | volume 18 | issue 2 | pages 244-252 INTRODUCTIONSeveral authors have reported a global increase in yeast infections over the past 20 years. Candida species can be found in the gastrointestinal tract of 20 to 80% of healthy adults, becoming pathogenic when host immune conditions are altered by offending factors (1). Of the invasive infections caused by Candida spp., blood infections, also known as candidemias, are the most clinically relevant (2). Candida spp. is currently one of the five main causes of blood infections in hospitals, and an increase in candidemia cases has been reported mainly in patients using antibiotics, under immunosuppressive therapy or parenteral nutrition, and in patients exposed to multiple invasive procedures (3,4). Candidemia is one of the most common blood infections in tertiary hospitals; it has also been associated with long stay in hospitals and high mortality (5-8).Although Candida albicans is the most frequent species isolated in patients with fungemia, cases of infections caused by other Candida species have increased (9-15). The frequency of C. albicans and other Candida species found in patients depends, among other factors, on the analyzed population and used therapy (16)(17)(18)(19). The most commonly found species in Brazilian candidemia patients are C. albicans, Candida parapsilosis, and Candida tropicalis (20). MATERIALS AND METHODSWe analyzed 98 yeast samples from different patients admitted to Botucatu Medical School University Hospital (HC-FMB) between 2000 and 2006 along with their medical records (obtained from the Statistical Medical Service -SAME, owned by HC-FMB). These patients developed symptoms of candidemia and samples were Sample size was calculated using the Fisher and Belle formula, with a 95% confidence interval and 5% precision for expected prevalence of fungemia patients. Beck-Sagué and Jarvis (21) study was used a...

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Controversies about the management of invasive fungal infections in very low birth weight infants

Cited by 11 publications

References 38 publications

Fungal colonization in newborn babies of very low birth weight: a cohort study

Fungal colonization in newborn babies of very low birth weight: a cohort study

Amphotericin B in neonates: deoxycholate or lipid formulation as first-line therapy – is there a ‘right’ choice?

Candidemia in a brazilian tertiary hospital: microbiological and clinical features over a six-year period

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