Persistently positive cultures and outcome in invasive neonatal candidiasis

Chapman, Rachel; Faix, Roger G.

doi:10.1097/00006454-200009000-00003

Cited by 107 publications

(67 citation statements)

References 19 publications

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“…We did not identify any patients with endocarditis. In contrast, Chapman et al 6 recognized an increased rate of focal complications and death in patients who had a positive repeat culture from a sterile site (urine, cerebrospinal fluid, blood or any other normally sterile site) >24 h after achieving target doses of amphotericin B or fluconazole. Natarajan et al 7 reported greater mortality in infants with refractory candidemia (defined as continuous positive blood cultures for Candida species between 48 and 72 h following treatment with both amphotericin B and fluconazole) compared with those who responded to these initial therapies.…”

Section: Discussionmentioning

confidence: 97%

“…This underscores the importance of prevention, prompt recognition and optimal treatment, including prompt central line removal, of invasive candidiasis. 3,6,8,9 The decision to begin empiric therapy (a modifiable risk factor) may have prevented persistent candidemia. In a majority of the cases of persistent candidemia (67%, n ¼ 6), treatment initiation followed initial culture collection by at least 1 day.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for persistent candidemia infection in a neonatal intensive care unit and its effect on mortality and length of hospitalization

et al. 2011

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Objective: Candida infections cause substantial morbidity and mortality in neonates. Persistent candidemia has not been associated with increased risk of mortality compared with candidemia of shorter duration. This study sought to determine whether persistent candidemia was associated with increased length of hospitalization or mortality in neonates.Study Design: A chart review was conducted of neonates with Candida bloodstream infections (n ¼ 37). Demographic, laboratory, pharmacy, nutrition and discharge data were abstracted. Contingency table analysis and logistic regression were used to analyze variables associated with persistent candidemia and mortality. The relationship between length of hospitalization and persistent candidemia was assessed with k-sample equality of medians test.Result: Nine patients (24%) had persistent candidemia. Increased time between blood culture draw and initial antifungal therapy was associated with increased incidence of persistent candidemia (P ¼ 0.03). Five patients (14%) died before hospital discharge; however, no deaths were attributed to persistent candidemia. Length of hospitalization was not increased with persistent candidemia. A decrease in the ratio of enteral feeding days to hyperalimentation days before collection of the first positive blood culture was significantly associated with an increase in all-cause mortality (P ¼ 0.03) and death attributed to candidemia (P ¼ 0.04). The risk of all-cause mortality decreased with a history of receiving any enteral feedings before the first positive blood culture (P ¼ 0.04), as did death attributed to candidemia (P ¼ 0.02). Conclusion:A duration of >1 day between the time of blood culture and the initial dose of systemic antifungal treatment places neonates at increased risk for developing persistent candidemia; however, this is not associated with increased mortality.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Risk factors for persistent candidemia infection in a neonatal intensive care unit and its effect on mortality and length of hospitalization

et al. 2011

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“…Consideration of a second antifungal agent may be warranted if there is evidence of an abscess, persistent candiduria, or 10 days of persistent organism isolation. 24,86 Improvement in rates of fungal clearance from 67 to 96% with the addition of a second antifungal agent has been noted. 87 There is debate regarding the need to remove central venous catheters (CVCs) in patients with invasive candidiasis.…”

Section: Management Of Candidiasismentioning

confidence: 99%

“…Improved outcomes have been noted in neonates with CVC removal. 24,86,88 Replacement of the CVC at a different site, when continued central access is required, has been proposed an alternative to discontinuation of the CVC. Because a majority of neonates are CVC-dependent for parenteral nutrition and antifungal therapy, the maintenance of venous access is obligatory.…”

Section: Management Of Candidiasismentioning

confidence: 99%

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

2013

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The definition of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble those of sepsis, especially in very low-birth-weight (VLBW) preterm infants and by the absence of optimal diagnostic tests. Although growth of an organism from a sterile site is the "gold standard" for definitive diagnosis, it is not always possible to isolate a causative pathogen. Invasive infections can occur in seemingly asymptomatic neonates. Therefore, assessment of history and risk factors in combination with diagnostic tests are used to identify neonates who are more likely to be infected.The definitions of early onset sepsis (EOS) and late onset sepsis (LOS) are subject to subspecialist variation. Many investigators, including those who participate in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Network and the Vermont Oxford Network, define EOS by the onset of signs/symptoms and an associated positive culture at or before 72 hours of life. LOS is characterized by the onset of symptoms consistent with sepsis at greater than 72 hours of life. These classifications of EOS and LOS reflect the differing etiologies and proposed pathophysiology of pathogens commonly associated with the timing of Keywords ► neonatal sepsis ► invasive candidiasis ► epidemiology ► management AbstractIdentifying neonates with sepsis is complicated by variability in clinical presentation. The incidence of early onset sepsis (EOS) resulting from invasive group B streptococcal (GBS) infections has been notably reduced by the widespread delivery of intrapartum antibiotic prophylaxis. Rates of EOS attributable to non-GBS etiologies have remained constant, and ampicillin-resistant Escherichia coli has become more prevalent. Lateonset sepsis (LOS) attributable to gram-positive organisms including coagulase-negative Staphylococci and Staphylococcus aureus is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of LOS, especially among infants who receive broad-spectrum antimicrobial agents. Prophylactic fluconazole administration to very low-birth-weight (VLBW) neonates during the first 6 weeks of life prevents invasive candidiasis in neonatal intensive care units (NICU) with high rates of fungal infections. Targeted fluconazole prophylaxis may be beneficial in VLBW neonates who receive care in NICUs with lower rates of invasive fungal infections. Assessment of immune function, neutrophil markers, acute phase reactants, and utilization of sepsis screening scores may contribute to the management of sepsis. Maternal decolonization, antimicrobial stewardship, early enteral feeding, and optimal infection control practices are potential practical strategies for reducing the burden of neonatal sepsis.

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“…There have been reports of neonates with candidal lens and retinal involvement, [10][11][12][13][14] but information regarding the incidences and natural history of candidal renal mycetoma, fungal endocarditis, and fungal brain abscesses among neonates is limited. [15][16][17][18][19][20][21][22][23][24] Ancillary testing including retinal examination, abdominal ultrasound and echocardiogram for all infants with candidemia has been suggested. 23 However, due to the uncertainty regarding the occurrence and severity of morbidities associated with invasive candidiasis, there is no consensus regarding the approach to ancillary diagnostic testing for infants with a positive blood, urine or CSF culture for a Candida species.…”

Section: Introductionmentioning

confidence: 99%