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

Rose, Domenico Umberto De; Santisi, Alessandra; Ronchetti, Maria Paola; Martini, Ludovica; Serafini, Lisa; Betta, Pasqua; Maino, Marzia; Cavigioli, Francesco; Cocchi, Ilaria; Pugni, Lorenza; Bonanno, Elvira; Tzialla, Chryssoula; Giuffrè, Mario; Bua, Jenny; Torre, Benedetta Della; Nardella, Giovanna; Mazzeo, Danila; Manzoni, Paolo; Dotta, Andrea; Bagolan, Pietro; Auriti, Cinzia

doi:10.3390/pathogens10030319

Cited by 20 publications

(15 citation statements)

References 107 publications

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“…The serological test results for Candida mannan antigen, antibody, and 1,3- β -d-glucan (BDG) were negative, while that of galactomannan (GM) was positive. Candida organisms can colonize the mouth and skin [ 12 , 13 ]. The culture samples were sputum obtained from nonsterile sites, which could be contaminated with oral pathogens, suggesting that, in these patients, Candida albicans could be part of the microbiota and not the causative pathogen of the infection.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Invasive Pulmonary Fungal Diseases Diagnosed by Pathological Examination

Zhang

Junquan

et al. 2021

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Objective. To explore the characteristics of invasive pulmonary fungal disease and the spectrum of pathogens causing invasive pulmonary fungal disease diagnosed by pathological examination using fungal stains. Methods. Patients with an invasive pulmonary fungal disease diagnosed by histopathological analysis through the use of fungal stains (including Grocott’s methenamine silver and periodic acid-Schiff stains) were included in this study. The clinical records, radiological reports, pathology, and fungal culture results were reviewed. Results. Forty-eight invasive pulmonary fungal disease patients diagnosed by histopathological analysis in the Tianjin Haihe Hospital (including 8 cases obtained by pulmonary resection, 35 cases by fiberoptic bronchoscopic biopsy, and 5 cases by percutaneous lung biopsy) were included. There were 24 male and 24 female patients, aged 21–80 years (53 ± 13 years). There were 37 cases of pulmonary aspergillosis, 4 cases of pulmonary cryptococcosis, 2 cases of pulmonary mucormycosis, and 5 in which pathogens were not determined due to limited tissue availability. Among 48 cases, 32 specimens were submitted to fungal culture. No fungus was detected in culture, although 26 cases of fungus infections were diagnosed by histopathological analysis. Only 3 cases were consistent between histopathological and culture results. In 3 cases, the pathogen was identified as Aspergillus spp. by the histopathological analysis, while the contrasting fungal culture results identified Candida albicans. Conclusion. Candida albicans pneumonia was rare, while aspergillosis was common in invasive pulmonary fungal disease diagnosed by histopathological analysis. The majority of patients with an invasive pulmonary fungal disease were culture-negative. Although culture can clarify the fungal pathogen species, it has low sensitivity. Pathological examination with fungal stains has its advantages in diagnosing fungal disease; therefore, more attention should be paid to the role of pathological examination in the diagnosis of fungal disease.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Invasive Pulmonary Fungal Diseases Diagnosed by Pathological Examination

Zhang

Junquan

et al. 2021

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…Recent population-based surveillance studies have shown an increasing incidence of invasive candidiasis in the neonatal ICU during the past decade [ 6 , 7 ]. An increased survival rate of extremely preterm neonates with long-term hospitalization and the widespread use of broad-spectrum antibiotics may account for the increasing incidence of invasive candidiasis [ 8 , 9 , 10 ]. Furthermore, more antifungal prophylaxis and the empiric use of echinocandins are reported to be associated with a continuous shift from C. albicans to various non- albicans Candida candidemia, which are more likely to be azole-resistant [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…There have been numerous studies that describe the epidemiology, clinical features, antifungal treatment, and outcomes of neonates with candidemia [ 6 , 7 , 8 , 9 , 10 ]. However, few researchers have investigated the reasons for the treatment failure of neonatal candidemia [ 5 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…The effects of the different therapeutic strategies on the final outcomes of candidemia are often concluded from adult patients or studies conducted in the surgical and pediatric ICUs or the hematological wards [ 2 , 15 , 16 ]. Additionally, the studies of neonatal candidemia were often limited by small sample sizes or lack of antifungal resistance or did not analyze the impact of different therapeutic strategies on outcome [ 2 , 6 , 7 , 8 , 9 , 10 , 13 , 14 , 15 , 16 ]. The aims of this study were to describe the clinical characteristics of neonates with candidemia, to present the results of antifungal susceptibility testing, and to assess the influences of different therapeutic strategies on the outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Microbiological Characteristics of Neonates with Candidemia and Impacts of Therapeutic Strategies on the Outcomes

Chen

Hsu

Chu

et al. 2022

JoF

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Neonatal candidemia is associated with significant morbidities and a high mortality rate. We aimed to investigate the clinical characteristics of Candida bloodstream infections in neonates and the impact of therapeutic strategies on the outcomes. We identified all the neonates with candidemia from a medical center in Taiwan over an 18-year period (2003–2021) and analyzed them. Clinical isolates were confirmed by DNA sequencing, and antifungal susceptibility testing was performed. The prognostic factors associated with clinical treatment failure (30-day, all-cause mortality and persistent candidemia > 72 h after antifungal agents) and in-hospital mortality were analyzed using logistic regression modeling. A total of 123 neonates with 139 episodes of candidemia were included in the study. The median (IQR) gestational age and birth weight of the neonates with candidemia were 29.0 (26.0–35.0) weeks and 1104.0 (762.0–2055) g, respectively. The most common Candida spp. was Candida albicans (n = 57, 41.0%), followed by C. parapsilosis (n = 44, 31.7%), Candida guilliermondii (n = 12, 8.6%), and C. glabrata (n = 11, 7.9%). The overall susceptibility to fluconazole was 81.3%, and the resistant rates against other antifungal agents were less than 3%. The cumulative mortality rate at 7 and 30 days after the first episode of candidemia was 11.3% and 32.3%, respectively. The overall in-hospital mortality rate was 42.3%. The treatment outcomes did not change over the study period and were not affected by delayed initiation of antifungal agents. Multivariate analysis showed that delayed catheter removal (odds ratio [OR], 5.54; 95% confidence interval [CI]: 1.93–15.86, p = 0.001), septic shock (OR, 7.88; 95% CI: 2.83–21.93, P < 0.001), and multiple chronic comorbidities (OR, 8.71; 95% CI: 1.82–41.81, p = 0.007) were independently associated with the final in-hospital mortality. We concluded that the overall mortality of neonatal candidemia has remained consistently high over the past decade. Prompt early catheter removal and an aggressive treatment strategy for neonatal candidemia with septic shock would be critical to improving patient outcomes.

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“…Congenital anomalies -also known as congenital disorders, congenital malformations, or birth defects -refer to the groups of structure, function, or metabolism abnormalities that cause physical or mental disabilities in newborns. Many of these congenital anomalies can be treated or improved with cost-effective and safe methods that improve long-term outcomes (4)(5)(6). Surgery is an important and life-saving health service that can treat many of these congenital anomalies (7,8).…”

Section: Introductionmentioning

confidence: 99%

Causes and results of non-cardiac surgeries in newborns admitted to the NICU

Eghbalian

Najafi

Pirdehghan

2021

J Shahrekord Univ Med Sci

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Background and aims: Surgery is an important and life-saving health service that can treat many of the congenital anomalies. This study aimed to investigate the possible causes and outcomes of non-cardiac surgeries in newborns admitted to the neonatal invasive care unit (NICU) department of Be’sat Hospital in Hamadan during the period 2011 to 2017. Methods: This study included all neonates (482 newborns) who were admitted to the NICU department of Be’sat hospital during the period 2011-2017 due to non-cardiac surgery, and had hospital records. The required information was extracted from their hospital records and the surgical outcomes and complications were analyzed with respect to other variables such as the gender, type of delivery, gestational age, birth weight, and disease. Results: According to our study results, 80.5% of the newborns had the gastrointestinal disease which was the most common cause of surgery found in this study. Moreover, imperforated anus (20.8%) and esophageal atresia (17.1%) were among the most common disorders. Esophageal atresia (33.9%) was detected to be the most common disease among the newborns who died during the course of the study. The results from the study showed that the outcome of surgery had statistically significant relationship with gender (P=0.011), type of breastfeeding/feeding (P<0.001), gestational age (P<0.001), and birth weight (P<0.001). Conclusion: Fetal examinations during pregnancy and neonatal care immediately after birth were recommended for early diagnosis of esophageal atresia, diaphragmatic hernia, and imperforated anus. Since gender (male), breastfeeding, normal gestational age, and normal birth weight had a significantly positive effect on surgery outcome, higher quality care was also recommended for infants lacking these characteristics.

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

Cited by 20 publications

References 107 publications

Characteristics of Invasive Pulmonary Fungal Diseases Diagnosed by Pathological Examination

Characteristics of Invasive Pulmonary Fungal Diseases Diagnosed by Pathological Examination

Clinical and Microbiological Characteristics of Neonates with Candidemia and Impacts of Therapeutic Strategies on the Outcomes

Causes and results of non-cardiac surgeries in newborns admitted to the NICU

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