Risk factors and outcomes of deep tissue Candida invasion in neonates with invasive candidiasis

Abstract

Background Deep tissue Candida invasion represents a special entity among neonates with invasive candidiasis. We aimed to explore the risk factors and clinical outcomes for deep tissue Candida invasion among neonates with invasive candidiasis. Methods A retrospective data review of neonates admitted to NICU of Madinah maternity and children hospital, KSA from January 2012 to December 2019 was done. Data were analysed between infants with or without deep tissue candidiasis among infants with invasive candidiasis. Invasive candidiasis was defined as positive blood or catheter collected urine culture for Candida. Deep tissue Candida invasion was defined as an infection of the central nervous system, eyes, heart, skeletal system, lungs, liver or kidneys. Result A total of 14 (11%) out of 130 neonates with invasive candidiasis had deep tissue Candida invasion. Persistent positive blood culture for Candida [OR 15.2, 95% CI (2.0–114), p = .01], prematurity [OR 7.6, 95% CI (1.04–56.4), p = .04] and prolonged antibiotic duration [OR 1.3, 95% CI (1.02–1.6), p = .03] are independent risk factors for deep tissue Candida invasion. Deep tissue Candida invasion was associated with significantly higher rates of cerebral palsy, hydrocephalus, heart failure and longer length of hospital stay compared to infants without deep tissue invasion. Conclusion Persistent Candida growth in blood cultures, prematurity and long‐term antibiotic use are significant risk factors for deep tissue Candida invasion. Deep tissue Candida invasion is associated with prolonged hospital stay and higher neonatal morbidity.

End-organ damage from neonatal invasive fungal infection: a 14-year retrospective study from a tertiary center in China

“…The lower mortality rate indicates that, in comparison to the treatment provided in developed countries, our level of treatment still requires significant enhancement. A retrospective study Saudi Arabia showed that a total of 14 (11%) out of 130 neonates with IFI had EOD, and mortality rate was 35.7% in EOD group and 28.4% in NEOD group with IFI [18]. This is consistent with our finding, which showed that the mortality rate in EOD group was significantly higher than that in NEOD group.…”

“…In this study, we tried to see whether these risk factors for IFI, such as BW and GA, were also risk factors for EOD, but the results were not as expected. Hanin et al found that persistent Candida growth in blood cultures, prematurity and long-term antibiotic use are significant risk factors for EOD, which prolongs the length of hospital stay and increases the neonatal morbidity [18]. However, in the present study, no significant correlation was found between prematurity and EOD, suggesting that both premature or full-term infants with IFI should be alert to the possibility of EOD.…”

“…End-organ damage (EOD) caused by neonatal IFI mainly refers to meningitis, endophthalmitis, brain parenchyma invasion, endocarditis, renal abscesses, positive cultures from other normally sterile body fluids, or hepatosplenic abscesses [17], which often lead to death or sequelae in infants. About 22% of infants with EOD to have cerebral palsy [18], and about 50% of infants with meningitis had NDI at 18 to 24 months corrected age [19]. Due to the difficulty of treatment, poor prognosis and medical burden, EOD infants often withdraw from treatment.…”

Fungal Colonization and Infections—Interactions with Other Human Diseases

“…Among the public health issues caused by microbes, fungal diseases are relatively neglected, owing to the low mortality rate of 1.5% globally [1]. Fungal diseases, also known as mycoses, although acknowledged in the late 1980s, have now captured greater attention than ever before because of the escalating population of high-risk elderly individuals, immunosuppressed individuals, transplant recipients, and premature neonates [2][3][4][5][6][7]. The average life expectancy has increased tremendously with our current scientific knowledge and advancements in medical treatments increasing the population size of individuals over 65 years of age.…”

Novel evidence on sepsis-inducing pathogens: from laboratory to bedside

“…Other risk factors for adult mortality with great representation across quantitative multivariate reports are concomitant bacteremia (Lee et al, 2020;Pieralli et al, 2021;Zhong et al, 2022;Gebremicael et al, 2023), high SOFA score (Bienvenu et al, 2020;Jung et al, 2020;Kutlu et al, 2022), presence of liver cirrhosis (González-Lara et al, 2017;Bartoletti et al, 2021;Battistolo et al, 2021;Meyahnwi et al, 2022), kidney dysfunction (Poissy et al, 2020;Mazzanti et al, 2021;Kutlu et al, 2022), and others summarized in Table 3 (Bassetti et al, 2020;Yoo et al, 2020;Kim et al, 2021). Particularly for early-age groups, additional risk factors for mortality include breakthrough candidemia , previous use of antibiotics for >2 weeks, persistent candidemia, and preterm gestation (<32 weeks; Eisi et al, 2022), placing the emphasis in the implementation and follow-up of protocols to properly manage neonatal care.…”