Neonatal fungal infections: when to treat?

Abstract

Candida infections are a major cause of morbidity and mortality in neonatal intensive care units. Mortality following Candida bloodstream infections is as high as 40%, and neurodevelopmental impairment is common among survivors. Because invasive fungal infections are common and extremely difficult to diagnose, empirical treatment with antifungal therapy should be considered in high-risk, low-birth-weight infants who fail to quickly respond to empirical antibacterial treatment. Risk factors to consider when deciding to administer empirical antifungal therapy include: prior exposure to third-generation cephalosporins, extreme prematurity, and presence of central venous catheters.

Neonatal sepsis: Highlighting the principles of diagnosis and management

“…[14][15] Risk factors for fungal sepsis include extremely low birth weight (ELBW), gestation <28 weeks, previous exposure to antibiotics (third-generation cephalosporins or carbapenems), thrombocytopenia, central venous lines, mechanical ventilation, use of antacids (histamine-2 blockers or proton-pump inhibitors), use of total parenteral nutrition, delayed enteral feeding, and prolonged hospital stay (>7 days). [3,14,16] A clinical predictive model for candidaemia is available (Table 1), [14,16] with a combined score of 2 having a sensitivity of 85%, and a moderate specificity of 47% for neonatal candidaemia. [16] Considering the high mortality for invasive fungal sepsis in neonates, it may be acceptable to use the candidaemia scoring model in empirical antifungal decision-making.…”

“…[3,14,16] A clinical predictive model for candidaemia is available (Table 1), [14,16] with a combined score of 2 having a sensitivity of 85%, and a moderate specificity of 47% for neonatal candidaemia. [16] Considering the high mortality for invasive fungal sepsis in neonates, it may be acceptable to use the candidaemia scoring model in empirical antifungal decision-making. The detection of (1,3)-β-D glucan to diagnose invasive fungal sepsis in neonates has also been proposed, although very few studies have included neonates.…”

“…[15] All patients with a positive fungal culture should have a full systemic evaluation (urine, blood, CSF, renal sonar, and fundoscopy) for invasive fungal sepsis. [16] Sterile urine specimens should be collected for urinalysis and culture in neonates suspected to have LOS ≥6 days of life. [4,5,11,17] Although there are no clear criteria for the diagnosis of urinary tract infections (UTIs) in neonates, [18] many clinicians use the following guide: growth of any urinary pathogen (≥1 000 CFU/mL) from a suprapubic specimen, or if a catheter specimen was taken, growth of ≥50 000 CFU/mL of a single uropathogen, or between 10 000 and 50 000 CFU/mL of a single uropathogen with evidence of pyuria.…”

Fungal Infections in Newborn

“…Yapılan çalışmalarda, 3. kuşak sefalosporin veya karbapenemlerin kullanılmasının yanısıra, verilen antibiyotik sayısının ve antibiyotiğin verildiği gün sayısının, H 2 reseptör antagonistlerinin ve parenteral beslenme kullanımının, entübasyonun ve hastanede yatışın uzun olmasının kandidemi için risk faktörleri arasında olduğu belirtilmiştir. Üçüncü kuşak sefalosporin kullanımı en güçlü ve değişti-rilebilir olan risk faktörü olarak belirtilmektedir (16)(17)(18)(19). Gastrik asiditenin gastrointestinal sistemi kandida kolonizasyonuna karşı koruduğu bilinmektedir.…”

Candida Colonization in Low Birth Weight and Very Low Birth Weight Infants in a Neonatal Intensive Care Unit

“…However, in the past decade, colonization with other species has increased and has been attributed to advancements in technology, life support systems, and relative immunodeficiency in the neonate, as well as horizontal transmission from the hands of health care workers and vertical transmission from maternal vaginal infection. Known risk factors for candidiasis infection include low birth weight (< 1,500 gr), prolonged use of broad-spectrum antibiotics, parenteral alimentation, intravenous fat emulsion, Candida colonization, a previous episode of mucocutaneous candidiasis, the presence of a central lines, prior colonization with another microbes, and prolonged urinary catheterization (14)(15)(16)(17)(18)(19). However, published literature regarding candidemia in NICUs in developing countries, such as Iran, is limited (20,21).…”