Epidemiology of and risk factors for neonatal candidemia at a tertiary care hospital in western China

Chen, Jichang; Jiang, Yongjiang; Ba, Wang; Ding, Yanling; Xu, Sen; Qin, Peixu; Fu, Jianhua

doi:10.1186/s12879-016-2042-9

Cited by 25 publications

(15 citation statements)

References 22 publications

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“…In the present study, the prevalence of 14.7% for fungal sepsis is similar to the rates of 11%, 13.6%, 13.9% and 11.97% reported by Rani et al, (28), Agarwal et al, (29), Chen et al, (30) and Chavhan et al, (27) respectively. In a previous study by Mokhtar et al,(11), the rate of fungal neonatal sepsis reported was 12% of the total diagnosed cases while bacterial sepsis represented 88%, but in the current study, fungal sepsis has increased to 14.7%.…”

Section: Discussionsupporting

confidence: 91%

Fungal neonatal and infantile sepsis in Egypt: Risk factors and identification of fungal isolates

Ahmed¹,

Mokhtar²,

El-Kholy³

et al. 2019

Af J Clin Exp Micro

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Background: Invasive fungal diseases (IFDs) are opportunistic infections associated with significant mortality in paediatric patients, especially in those with compromised immune system and neonates with very low birth weight (VLBW). The objectives of this study are to determine the prevalence, clinical features and fungi isolates of neonatal sepsis in three hospitals in Egypt. Methodology: The study is a cross sectional survey of 176 neonates with clinical sepsis admitted to the neonatal intensive care units (NICU) of the three hospitals over a period of one year (February 2015 to January 2016). A minimum of two blood samples (collected within 24 hours) from each neonate were cultured for bacteria in automated BacT/AlerT and conventional culture bottles, while Saboraud-Brain Heart Infusion broth was inoculated for fungi culture. Positive growths from the broth were sub-cultured on Sabouraud Dextrose Agar (SDA) plates for aerobic incubation at 25 o C and 37 o C for 2 weeks. Identification of fungi colonies on SDA was by conventional morphology and confirmation on chromogenic agar media. Phylogenetic analysis of representative fungi isolates was done by partial nucleotide sequencing of D1-D2 domain of the large subunit rRNA gene. Results: Of the 176 neonates, blood culture was positive for pathogens in 55 (31.3 %) samples and fungi were isolated in 26 (14.8 %); yeast (25) and mould (1). The commonly isolated yeasts were Candida albicans, Candida tropicalis, and Candida krusei representing 34.6%, 30.8% and 23.1%, respectively of the total fungi isolated. The phylogenetic analysis in comparison to Genbank data showed defined clades for Candida tropicalis, Candida parapsilosis, Candida albicans and Pichia kudriavzevii Conclusion: This current study highlights the changing pattern of neonatal infections in Egypt caused by Candida, with increasing incidence of infections caused by non-albicans Candida species.

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Section: Discussionsupporting

confidence: 91%

Fungal neonatal and infantile sepsis in Egypt: Risk factors and identification of fungal isolates

Ahmed¹,

Mokhtar²,

El-Kholy³

et al. 2019

Af J Clin Exp Micro

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“…Because of their immature immune system, neonates are particularly vulnerable to invasive candidemia. Incriminated factors include prolonged endotracheal intubation, total parenteral nutrition (TPN), indwelling venous catheterization, and broad-spectrum antibiotics (3). While Candida albicans has long been accountable for the major-ity of candidemia cases, non-albicans Candida spp.…”

Section: Introductionmentioning

confidence: 99%

Candidemia in the Neonatal Intensive Care Unit: Insights on Epidemiology and Antifungal Drug Susceptibility Patterns

Hassan

Yousef

Elhamed

et al. 2018

Arch Pediatr Infect Dis

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Background: Being the culprit in 9%-13% of neonatal bloodstream infections (BSIs), candidemia has been escalating to worrisome levels in the past few decades. While C. albicans has traditionally been the most common isolate, non-albicans Candida spp. are currently gaining a foothold. Objectives: We endeavored to investigate the epidemiological features of neonatal candidemia with special emphasis on nonalbicans candidemia. Hence, we evaluated the incidence, risk factors, antifungal susceptibility, and case fatality rate of candidemia patients in the NICU. Methods: Blood samples were collected from 1296 neonates admitted to the NICU of a tertiary care hospital. Then, only neonates with positive blood cultures were enrolled. Incidence and risk factors of albicans and non-albicans candidemia were evaluated. The Etest was employed to determine the minimum inhibitory concentrations of fluconazole, itraconazole, voriconazole, amphotericin B, and caspofungin. Results: Out of 214 neonates with BSI, candidemia afflicted 32 neonates (15%). The predominant isolate was C. tropicalis (43.8%), followed by C. albicans (25%). Both antibiotic use and antifungal prophylaxis were contributing factors (P values of 0.02 and < 0.01, respectively). Susceptibility testing revealed that 87.5% of the retrieved Candida isolates were sensitive to amphotericin B, 81.25% to fluconazole, 75% to voriconazole, and 62.5% to itraconazole while 48.75% were sensitive to caspofungin. Conclusions: Neonatal candidemia often carries an ominous prognosis. The worldwide progressive shift towards non-albicans candidemia necessitates regular surveillance and monitoring of laboratory data. An epidemiological knowledge is critical in terms of preemptive management that should encompass disciplined infection control practices and a restrictive policy for antibiotic and antifungal prophylaxis.

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“…La tasa de incidencia hospitalaria de Candida en el estudio fue de 20 por cada 1.000 admisiones, siendo elevada al compararse con otros estudios como el de Feja et al 6 en Nueva York, Fu et al 9 y Chen et al 10 en China y Pinhat et al 11 en Brasil siendo 15.9, 13.6, 10.6 y 9.0 por cada 1.000 admisiones respectivamente. Dentro de las posibles razones asociadas a la elevada incidencia de candidemia en nuestra institución, se pueden mencionar: el hacinamiento diario (censo por arriba de la capacidad), el poco personal médico y de enfermería (relación numérica por paciente), la alta complejidad de las patologías, ser un centro de referencia nacional y el uso indiscriminado de antibióticos de amplio espectro.…”

Section: Discussionunclassified

“…El 49% de los casos de candidemia fue causado por Candida parapsilosis similar a lo expuesto en los estudios Yu et al 12 , Rodríguez et al 13 , Neu et al 14 , Celebi et al 15 y Caggiano et al 16 A diferencia, otros estudios, Feja et al 6 , J. Fu et al 9 , Chen et al 10 , Saiman et al 17 , Robinson et al 18 , Juyal et al 19 , Hsu et al 20 y Márquez et al 21 , donde se describe que la especie de predominio fue Candida albicans.…”

Section: Discussionunclassified

“…Estos factores de riesgo aparecen como estadísticamente significativos en la literatura; la intervención quirúrgica como factor de riesgo ha sido mencionada previamente en el estudio de Ávila-Agüero et al 28 en base a la disrupción de las barreras cutáneas y epiteliales para la invasión del torrente sanguíneo por Candida. La estancia intrahospitalaria y el uso de meropenem han sido identificados como factores de riesgo en estudios por Fu et al 9 , Chen et al 10 , Yu, et al 12 , Saiman et al 17, Stoll et al 29 , Benjamin et al 30 y Hsu et al 31 Se ha encontrado que los antibióticos carbapenémicos (Meropenem) pueden contribuir a la proliferación de microorganismos oportunistas como Candida, al reducir la presión competitiva ejercida por la flora bacteriana normal. 9 Un estudio por Kaufman et al 32 mostró que la disminución del uso de carbapenémicos está asociado al descenso de la incidencia de infecciones por Candida.…”

Section: Discussionunclassified

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Factores de riesgo y letalidad asociados a Candidemia Neonatal en una unidad de neonatología

et al. 2019

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Objetivo: Determinar los principales factores de riesgo asociados a candidemia en neonatos.Pacientes y Método: Se realizó un estudio de casos y controles retrospectivo pareado, desde enero de 2014 a diciembre de 2016. Los casos fueron pacientes con aislamiento en hemocultivo y/o líquido cefalorraquídeo de Candida spp. luego de sus primeras 48 horas intrahospitalarias y los controles fueron neonatos escogidos del censo estadístico de la sala de neonatología pareados según su fecha de admisión a sala (rango de 30 días), peso al nacer, edad gestacional y condición de egreso (vivo o fallecido). Por cada caso seleccionamos dos controles. Los factores de riesgo evaluados fueron la estancia intrahospitalaria mayor a 7 días, el uso de antibióticos de amplio espectro, ventilación mecánica, nutrición parenteral mayor a 5 días, procedimientos invasivos como colocación de accesos venosos centrales y cirugías abdominales y torácicas, enterocolitis necrosante y crecimiento de microorganismo bacteriano en hemocultivo previo a la candidemia.Resultados: Durante el período de estudio hubo aislamiento de Candida spp. en 141 neonatos. Se encontró que el 49% fue de Candida parapsilosis con la mayor letalidad asociada. En el análisis multivariado se identificaron como factores de riesgo la estancia intrahospitalaria mayor a 7 días (OR = 17,0, 95% IC = 2,36-122,4), uso de líneasumbilicales (OR = 9,04, 95% IC = 1,55-52,5), exposición a cirugía (OR = 12,4, 95% IC = 1,76-87,3) y el uso de meropenem (OR = 4,62, 95% IC = 1,34-15,9).Conclusión: La estancia intrahospitalaria prolongada mayor a 7 días y la exposición a cirugía fueron los factores de riesgo más importantes en este estudio para el desarrollo de candidemia neonatal.

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Epidemiology of and risk factors for neonatal candidemia at a tertiary care hospital in western China

Cited by 25 publications

References 22 publications

Fungal neonatal and infantile sepsis in Egypt: Risk factors and identification of fungal isolates

Fungal neonatal and infantile sepsis in Egypt: Risk factors and identification of fungal isolates

Candidemia in the Neonatal Intensive Care Unit: Insights on Epidemiology and Antifungal Drug Susceptibility Patterns

Factores de riesgo y letalidad asociados a Candidemia Neonatal en una unidad de neonatología

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