Neonatal invasive fungal infection in England 2004–2010

Abstract

Rates of invasive fungal infection are highest among neonates, especially those of low birthweight. This study aimed to describe the current epidemiology of invasive neonatal fungal infections in a UK neonatal infection surveillance network. From 2004 to 2010 prospective multicentre surveillance was conducted by 14 neonatal units using a web-based database. Clinicians then completed a standardized pro forma for each positive fungal blood and/or cerebrospinal fluid culture. The overall incidence was 2.4/1000 neonatal unit admissions and was highest among babies <1000 g (extreme low birthweight, 18.8/1000). Only five infants (6%) were >1500 g. The majority of infections were caused by Candida albicans (59; 69%) and Candida parapsilosis (17; 20%); 33% of infants had received antifungal prophylaxis. Known risk factors (use of central venous catheter, parenteral nutrition, previous antibiotic use) were common among cases. The attributable case fatality rate was 21% (18/84). Extreme low birthweight infants remain at highest risk of invasive fungal infection and prophylaxis should be particularly considered for this group. The number needing to receive prophylaxis to prevent one case varies significantly among units, hence unit-specific decisions are required. Further research is still needed into the optimal empiric and therapeutic strategies.

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

“…In the present study, we found that the overall incidence of candidemia among VLBW infants was 84.6 per 1000 admissions, and in the ELBW group, the candidemia incidence was 303.0 per 1000 admissions. These findings are consistent with the results of a study based on surveillance data collected in England between 2004 and 2010, which reported that ELBW infants had the highest risk of invasive Candida infection of the neonates evaluated [2]. During the 4-year period evaluated in our study, only 33 ELBW infants survived and were admitted to the NICU after delivery.…”

“…Previous studies, especially those conducted in western countries, have frequently reported that C. albicans was the most common causative agent of neonatal candidemia, followed by C. parapsilosis [2]. In contrast with the results of some previous studies, the results of our study paralleled those of a previous study conducted by Xia et al [4], who reported that C. albicans was the species most commonly identified in Chinese 11 NICU centers, followed by C. glabrata .…”

“…Fluconazole is considered as the first line antifungal agent in our hospital. Previously, a study showed that pre-exposure to fluconazole was a predisposing factor for C. glabrata infection [7], which may partly explain the observed discrepancy regarding the distribution of Candida among neonates, as most NICUs have been reported to use liposomal amphotericin B when administering prophylactic or empiric therapy [2]. …”

“…It has been estimated that 2.4–9.0% of mortality [1, 2] and 25.0% of morbidity [3] in the NICU setting may be attributable to Candida infections.…”

Clinical and molecular characteristics of bloodstream infections caused by Candida albicans in children from 2003 to 2011

“…In addition to the clinical characteristics of C. albicans BSIs in children, this study aimed to contribute to a long-term genetic database of C. albicans BSI isolates of Taiwanese children for global epidemiology [32,33] and investigate whether different characteristics can be attributed to certain specific molecular types in our hospital. In the present study, we did not identify any specific molecular type which could be strongly correlated with certain patient characteristics, drug resistance, or treatment outcomes.…”