Candidaemia in special care nurseries: comparison of albicans and parapsilosis infection
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1Division of Paediatric Infectious Diseases, Chang Gung Children's Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan.
Objectives:
Candidaemia caused by Candida parapsilosis (CP) is being increasingly reported among infants in neonatal intensive care units (NICU). To assess relative severity, clinical manifestations of candidaemia caused by C. albicans (CA) and CP in a NICU were compared.
Methods:
Between January 1994 and July 1997, episodes of candidaemia occurring among infants hospitalized in the NICU were identified in a children's hospital. The demographic characteristics, associated risk factors, clinical manifestations and outcome of the infants with CP fungaemia were collected and compared with those of the infants with CA fungaemia.
Results:
Twenty-four episodes caused by CA and 22 episodes caused by CP were included in this study. No significant differences were found between the two groups for gestational age, birth weight, male gender, post-natal age at onset of candidaemia, frequency of antecedent neonatal events, prior duration of antibiotic therapy and hyperalimentation, as well as presence of central venous catheter (CVC). Infants with CA fungaemia were significantly more likely than those with CP fungaemia to present with hypoxaemia, bradycardia and respiratory distress requiring intubation, and have a longer prior duration of indwelling CVC and a higher dissemination rate. The eradication rate of candidaemia and overall case fatality rate were comparable in both groups. but CP fungaemia did not appear to cause acute lethal events.
Conclusion:
The presenting signs of CP fungaemia are relatively not so severe, but CP fungaemia, which is relatively difficult to eradicate, increases the morbidity and mortality of the infants.
Insights
Candida parapsilosis (CP) bloodstream infections in neonates are less severe initially than Candida albicans (CA) but are harder to eradicate, increasing infant mortality. This study compared clinical outcomes in a neonatal intensive care unit (NICU).
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Mycology
Background:
- Candidaemia caused by Candida parapsilosis (CP) is rising in neonatal intensive care units (NICUs).
- Assessing the relative severity of CP versus Candida albicans (CA) infections is crucial for neonatal care.
Purpose of the Study:
- To compare the clinical manifestations and outcomes of candidaemia caused by C. albicans and C. parapsilosis in a NICU setting.
Main Methods:
- A retrospective study identified episodes of candidaemia in infants hospitalized in a NICU between January 1994 and July 1997.
- Demographic data, risk factors, clinical signs, and outcomes for infants with CP fungaemia were compared to those with CA fungaemia.
Main Results:
- No significant differences were observed in infant demographics or common risk factors between the CP and CA groups.
- Infants with CA fungaemia were more likely to exhibit hypoxemia, bradycardia, and respiratory distress requiring intubation.
- While overall fatality rates were similar, CP fungaemia showed a higher dissemination rate and was more difficult to eradicate, contributing to increased infant morbidity.
Conclusions:
- Candida parapsilosis fungaemia presents with less severe initial symptoms compared to Candida albicans.
- Despite milder initial signs, CP fungaemia poses a significant challenge due to difficulties in eradication, leading to increased infant morbidity and mortality.
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