Risk factors and clinical analysis of peripherally inserted central catheter-related fungal colonization in premature infants

Abstract

We aimed to analyze the risk factors of positive peripherally inserted central catheter (PICC)-related fungal colonization in preterm infants. This retrospective study collected data from 2018 to 2020. The enrolled infants who underwent PICC insertion were born at < 32 weeks’ gestation or birth weight < 1500 g. The demographics, PICC-related characteristics, and treatment information were collected. Univariate and multivariate analyses were performed to investigate risk factors for PICC-related fungal colonization. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for the duration of antibiotics and parenteral nutrition. In total, 124 premature infants underwent PICC insertion. Among them, 19 patients had positive results of fungi on the PICC tips. The duration of antibiotics (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.02–1.31), parenteral nutrition infusion (OR 1.27, 95% CI 1.05–1.54), and postnatal glucocorticoid exposure (OR 9.48, 95% CI 1.06–84.98) were independent risk factors for fungal colonization in PICCs. The ROC curves showed that the risk increased after 15 days of antibiotic use and 28 days of parenteral nutrition infusion. Appropriate clinical management should be used to prevent fungal colonization and fungemia.

The Nonbacterial Microbiome: Fungal and Viral Contributions to the Preterm Infant Gut in Health and Disease

“…Diminished bacterial biomass in the gut then allows for fungal expansion and overgrowth, with a fraction of these fungal colonization events resulting in infection [114][115][116]. Interplay among the preterm immature immune system, underdeveloped intestine, and dysbiosis, along with environmental risk factors such as total parenteral nutrition, invasive catheters and endotracheal tubes, and medications [75,79,83,112,117,118] results in systemic, invasive candidiasis in 10% of preterm infants, with a mortality rate approaching 20% [119,120] and a host of associated long-term morbidities [115]. While fungal infections are thought to be an extraordinarily rare cause of preterm NEC [121][122][123], the weakened intestinal barrier of an infant with NEC may allow for Candida coinfection [124][125][126], resulting in, for example, fungal sepsis following surgical NEC treatment [127].…”

Medical Device-Associated Healthcare Infections: Sterilization and the Potential of Novel Biological Approaches to Ensure Patient Safety

“…Aspergillus biofilms have been detected on catheters, prosthetic devices, pacemakers, heart valves, and breast implants [45]. Zhang et al (2021) described the detection of fungi on 67% of peripherally inserted central vein catheters [51]. C. neoformans biofilms have been detected on ventriculoarterial shunt catheters, polytetrafluoroethylene peritoneal dialysis fistula, and prosthetic cardiac valves [44].…”