Invasive Fungal Infections in Neonates in Canada

Ting, Joseph; Roberts, Ashley; Synnes, Anne; Canning, Roderick; Bodani, Jaya; Monterossa, Luis; Shah, Prakesh S.

doi:10.1097/inf.0000000000001968

Cited by 41 publications

(45 citation statements)

References 39 publications

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“…Similar studies in Egypt 12 , Australia 13 , and Mexico 19 have also reported results consistent with the above publications, confirming the risk of prolonged exposure to antibiotics in VLBW neonates. The results of these publications [9][10][11][12][13][17][18][19] are similar to the findings of this study, in which it was observed that prolonged exposure (≥5 days) to empirical antibiotics after birth increased the risk of late sepsis and NEC, OR=1,88, and OR=9,71 respectively. It should be noted that in all these reports [9][10][11][12][13][17][18][19] , the studied population has similar characteristics (very low or extreme low weight NBs).…”

Section: Discussionsupporting

confidence: 87%

“…The results of these publications [9][10][11][12][13][17][18][19] are similar to the findings of this study, in which it was observed that prolonged exposure (≥5 days) to empirical antibiotics after birth increased the risk of late sepsis and NEC, OR=1,88, and OR=9,71 respectively. It should be noted that in all these reports [9][10][11][12][13][17][18][19] , the studied population has similar characteristics (very low or extreme low weight NBs). On the other hand, there is a high rate of positive blood cultures (65.6%) among the cases of late clinical sepsis in this study, where the most frequently isolated microorganism is the coagulase-negative Staphylococcus, which is consistent with what has been reported in other studies 9,11,13 .…”

Section: Discussionsupporting

confidence: 87%

“…Despite the solid evidence reported in the above studies [9][10][11][12][13][17][18][19] , the excessive and inadequate use of empirical antibiotics is a reality in many health centers. A clinical analysis with a cohort of 742 extremely low birth weight neonates with negative blood cultures reported that 60% of the NBs received empirical antibiotics for more than three days 20 , concluding that the duration of initial empirical antibiotic therapy was an institutional decision and not based on obvious clinical signs and symptoms of infection 20 .…”

Section: Discussionmentioning

confidence: 99%

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Edulcorantes No Nutritivos (No Calóricos)

Torres

Muñoz

Bancalari

et al. 2018

Rev. chil. pediatr.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Edulcorantes No Nutritivos (No Calóricos)

Torres

Muñoz

Bancalari

et al. 2018

Rev. chil. pediatr.

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“…care units (NICUs) in Canada revealed that although C. albicans remains the major cause of neonatal invasive Candida disease (59%), C. parapsilosis is also highly prevalent (21%) (54). Recently, cases from European countries were also reported.…”

Section: Introductionmentioning

confidence: 99%

Candida parapsilosis: from Genes to the Bedside

et al. 2019

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SUMMARY Patients with suppressed immunity are at the highest risk for hospital-acquired infections. Among these, invasive candidiasis is the most prevalent systemic fungal nosocomial infection. Over recent decades, the combined prevalence of non-albicans Candida species outranked Candida albicans infections in several geographical regions worldwide, highlighting the need to understand their pathobiology in order to develop effective treatment and to prevent future outbreaks. Candida parapsilosis is the second or third most frequently isolated Candida species from patients. Besides being highly prevalent, its biology differs markedly from that of C. albicans, which may be associated with C. parapsilosis’ increased incidence. Differences in virulence, regulatory and antifungal drug resistance mechanisms, and the patient groups at risk indicate that conclusions drawn from C. albicans pathobiology cannot be simply extrapolated to C. parapsilosis. Such species-specific characteristics may also influence their recognition and elimination by the host and the efficacy of antifungal drugs. Due to the availability of high-throughput, state-of-the-art experimental tools and molecular genetic methods adapted to C. parapsilosis, genome and transcriptome studies are now available that greatly contribute to our understanding of what makes this species a threat. In this review, we summarize 10 years of findings on C. parapsilosis pathogenesis, including the species’ genetic properties, transcriptome studies, host responses, and molecular mechanisms of virulence. Antifungal susceptibility studies and clinician perspectives are discussed. We also present regional incidence reports in order to provide an updated worldwide epidemiology summary.

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“…11 Furthermore, antibiotic use in VLBW infants without culture proven sepsis or NEC, was found to be associated with an adverse composite neonatal outcome defined as mortality or major morbidity, including persistent periventricular echogenicity or echolucency on neuroimaging, chronic lung disease, and stage-3 or higher retinopathy of prematurity. 12 Adjuvants in the diagnosis of culture-negative sepsis: Molecular techniques, such as PCR, are considered more sensitive and rapid than blood cultures and may identify ultra-low bacteremia that may not require treatment. A Cochrane review concluded that they may perform well as "add-on" tests.…”

Section: Definitionsmentioning

confidence: 99%

Do Neonatal Infections Require a Positive Blood Culture?

2020

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Neonatal sepsis is a major cause of worldwide morbidity and mortality. Blood cultures are considered the gold standard for diagnosis, but results are often delayed for 24 to 48 hours, and sensitivity, although improved by modern techniques, such as automated blood cultures, is variable and affected by the bacterial load. For these reasons, empiric antibiotics are frequently administered to avoid potential devastating consequences of untreated sepsis. Unnecessary antibiotic treatment has been associated with increased mortality and other adverse outcomes; therefore, antibiotics should be discontinued as soon as sepsis has been ruled out. Negative cultures pose a challenge to clinicians, who must distinguish between real sepsis and sepsis-like conditions (noninfectious or viral) which do not require antibiotics. Focal infections with negative blood cultures do require antibiotic treatment. Ultra-low bacteremia, primary or secondary to recent antibiotic exposure, is often associated with negative cultures, and some consider a short course of empiric antibiotics sufficient for clearing of bacteremia. Biomarkers and molecular methods based on polymerase chain reaction are important add-ons to clinical signs or symptoms for establishing the diagnosis of sepsis. Other promising future potential adjuvants are metabolomics. Antibiotic stewardship should be implemented to avoid or discontinue unnecessary treatment. Prevention of infection still remains the most important step for dealing with neonatal sepsis. Key Points

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Invasive Fungal Infections in Neonates in Canada

Abstract: The overall incidence of IFI in neonates was low in Canada in comparison to other large population cohort studies; however, the mortality and morbidity remained high.

Cited by 41 publications

References 39 publications

Edulcorantes No Nutritivos (No Calóricos)

Edulcorantes No Nutritivos (No Calóricos)

Candida parapsilosis: from Genes to the Bedside

Do Neonatal Infections Require a Positive Blood Culture?

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