Invasive fungal infection in neonatal intensive care units: a multicenter survey

Abstract

This study assesses the epidemiology of invasive fungal infection (IFI) in Portuguese Neonatal Intensive Care Units (NICUs) and compares the effectiveness and safety of antifungal therapies. A survey concerning the period 2005-2010 was carried out in NICUs of Greater Lisbon. Among 10 473 admitted neonates, 44 cases were identified, 29 among extreme low birth weight neonates (65.9%). Cumulative incidence rate was 0.42% (95%CI 0.309-0.559). A central vascular catheter was present before IFI in all cases. Candida albicans and Candida parapsilosis were the most frequent isolates. The initial antifungic was fluconazole in 22 cases and liposomal amphotericin B (L-AmB) in 18. Therapy was switched in 10 patients on fluconazole and 3 on L-AmB. Case fatality rate was 11.4% (95%CI 4.39-23.91). No serious adverse drugs reactions (SADRs) or clinical side effects were observed. The knowledge of the local epidemiology helps to identify adequate prophylactic and treatment strategies.

Poor in vivo efficacy of caspofungin, micafungin and amphotericin B against wild-type Candida krusei clinical isolates does not correlate with in vitro susceptibility results

“…8,35 Amphotericin B used at clinically attainable concentration showed weak in vitro killing activity against C. krusei regardless of test media, which was confirmed in vivo as well. [3][4][5][6] Our results correlate with previous in vitro and in vivo findings that amphotericin B is not superior to echinocandins for the treatment of invasive infections caused by C. krusei. 8 However, currently there is no alternative in echinocandin resistant cases.…”

“…1,2 For many decades, amphotericin B was the only systematically used antifungal agent for the treatment of invasive C. krusei infections; however, in vitro and in vivo data suggest that efficacy of amphotericin B is strongly questionable against C. krusei. [3][4][5][6] As echinocandins (anidulafungin, caspofungin and micafungin) show relatively low MIC values and concentration-dependent fungicidal activity against C. krusei in vitro, currently echinocandins are among the preferred antifungals against C. krusei, besides amphotericin B and voriconazole. 7,8 However, mortality rate due to invasive infections by C. krusei among intensive care unit patients is still unacceptably high (50-70%) even with the widely used echinocandin therapy.…”

Incidencia de fungemia en la unidad de recién nacidos del Hospital Universitario San Ignacio de Bogotá en el periodo comprendido desde el 01 de enero de 2008 hasta el 31 de diciembre de 2018

“…Las infecciones representan el 36% de las muertes neonatales anuales 1 , siendo la sepsis tardía responsable del 21% de muertes en recién nacidos de muy bajo peso al nacer 2 ; cantidad aún más alarmante cuando se trata de infección fúngica invasora (IFI), dado que la mortalidad es un desenlace frecuente que se presenta hasta en un 25-55% de los casos 3 . Esta corresponde a la tercera causa de infecciones 2 , genera una carga económica importante para los sistemas de salud y disminuye el vínculo de madre e hijo 2,4 .…”

“…Por otro lado, hablando de agentes infecciosos: Candida albicans es el agente más frecuentemente aislado (69% de los casos), pero también se han documentado Candida no albicans; principalmente parapsilopsis (11-58%), seguida de glabrata (23%) y, en menor proporción Candida tropicales, guillermondi, orthopsilosis, krusei y lusitaniae (en ningún caso mayor del 2%). Así mismo, hay informes de micosis invasiva por Malassezia pachydermatis, Aspergillus fumigatus y flavus, Cryptococcus, Zygomicosis y Trichosporidio 4,5,[10][11][12][13][14][15][16][17] .…”

“…Existen unos primarios como: edad gestacional, principalmente prematuridad extrema, y muy bajo peso al nacer. Y otros secundarios como: uso previo y prolongado de antibiótico de amplio espectro, alimentación parenteral, procedimientos quirúrgicos (sobre todo abdominales), uso de catéter venoso central y ventilación mecánica, al igual que factores inmunosupresores como uso previo de corticoides [2][3][4][5][6]15 .…”