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Yeast colonisation & fungaemia in preterm neonates in a tertiary care centre
K Singh1, A Chakrabarti, A Narang
1Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh.
Insights
Preterm neonates frequently experience yeast colonization, especially those under 1500g. Routine surveillance for yeast colonization and risk factors is crucial for preventing fungemia in vulnerable infants.
Area of Science:
- Neonatal Medicine
- Medical Mycology
- Infectious Diseases
Background:
- Preterm neonates are susceptible to infections due to immature immune systems.
- Hospitalization increases the risk of healthcare-associated infections, including fungal colonization and fungemia.
- Yeast colonization is a known precursor to invasive fungal infections in neonates.
Purpose of the Study:
- To investigate the prevalence and patterns of yeast colonization in hospitalized preterm neonates.
- To identify common yeast species colonizing preterm infants.
- To determine the incidence of fungemia and associated risk factors in this population.
Main Methods:
- Prospective study of 70 preterm neonates hospitalized for over seven days.
- Collection of samples from oral, umbilical, groin, and rectal sites for yeast colonization assessment.
- Screening for fungemia and identification of causative yeast species.
- Analysis of risk factors associated with colonization and fungemia.
Main Results:
- 71.4% of neonates were colonized by yeast, with 38% colonized within 24 hours of admission.
- Neonates weighing <1500g showed higher rates of multi-site colonization and yeast load.
- Predominant colonizing yeasts included Candida albicans, Pichia (Hansenula) anomala, and Candida tropicalis.
- Fungaemia occurred in 22.8% of neonates, primarily caused by P. anomala.
- Significant risk factors for fungemia included prematurity, male sex, broad-spectrum antibiotics, intubation, and higher colonization rates.
Conclusions:
- High rates of yeast colonization are observed in preterm neonates, with low birth weight being a key factor.
- Pichia (Hansenula) anomala is a significant cause of fungemia in this cohort.
- Routine surveillance for yeast colonization and identification of risk factors are essential for effective prevention and management of fungemia in preterm infants.
Abstract:
Seventy consecutive preterm neonates who stayed in the hospital for more than seven days between March and October 1996, were studied for colonisation at oral, umbilical, groin, and rectal areas and for fungaemia. Overall, 71.4 per cent of the neonates were colonised and colonisation occurred within 24 h in 38 per cent preterm neonates. Neonates weighing less than 1500 g were colonised more frequently at more than one site and had higher load of yeast. Candida albicans (19%), Pichia (Hansenula) anomala (17.5%), C. tropicalis (13.2%), C. parapsilosis (12.3%) and Trichosporon cutaneum (10.0%) were the predominant colonising yeasts. Fungaemia was detected in 22.8 per cent of preterm neonates with predominance of P. anomala fungaemia (62.5%). Prematurity, male sex, broad spectrum antibiotic therapy, intubation and higher colonising rate were identified as significant risk factors for development of fungaemia. Except one strain of C. tropicalis, all yeast strains were sensitive to commonly used systemic antifungal agents. Study highlights the importance of routine surveillance of yeast colonisation of preterm neonates with identifying possible risk factors.