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Published on: August 12, 2020
Low yield of ancillary diagnostic studies in neonates infected with Candida
Christopher E Colby1, Laura Drohan, William Benitz
1Division of Neonatology, Mayo Clinic, Rochester, MN, USA.
Background:
Fungal infection can be a significant complication for the critically ill neonate. However, the usefulness of extensive radiologic and ophthalmologic investigations in this population has not been thoroughly elucidated.
Objective:
To report the incidence of organ fungal involvement diagnosed by ancillary testing (echocardiogram, ophthalmologic examination, brain imaging, and renal ultrasound (RUS)) among neonatal intensive care unit (NICU) patients with Candida infection.
Methods:
This was a single center review of all NICU patients with Candida-positive cultures of blood, urine, peritoneal fluid, endotracheal tube aspirate, or cerebrospinal fluid from January 1, 1997 to June 1 2002. Data regarding the number of positive cultures, species isolated, and presence of specific risk factors and clinical symptoms were recorded for each case, as well as occurrence, timing and results of ancillary testing.
Results:
In all, 66 patients had at least one positive culture for Candida. The majority (71%) were <1500 g at birth, and mean gestational age was 29.5+/-5.6 weeks. Echocardiograms were obtained in 54/66 (82%), and ophthalmology examinations were obtained in 36/66 (55%); none of these was consistent with fungal involvement. Brain imaging was performed in 50/66 (76%), only one of which was positive, in a patient with 16 positive blood cultures for Candida albicans. RUS were performed in 58/66 (88%) of patients, with concerning findings for fungal involvement in seven of the studies. RUS findings alone did not appear to consistently influence the length of therapy.
Conclusions:
Ancillary evaluations to investigate for fungal dissemination were undertaken frequently, but were of overall low yield. Although ancillary testing may be of limited additional value in centers with a low threshold for suspecting fungal infections and an aggressive approach to therapy, potentially important findings, which could impact management, may occur.
Insights
Extensive radiologic and ophthalmologic investigations in critically ill neonates with Candida infection rarely identify organ involvement. These tests have a low yield, suggesting a targeted approach to fungal infection diagnosis may be more effective.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Medical Imaging
Background:
- Fungal infections pose significant risks to critically ill neonates.
- The diagnostic utility of extensive investigations for fungal dissemination in neonates is not well-established.
Purpose of the Study:
- To determine the incidence of organ fungal involvement using ancillary tests in neonatal intensive care unit (NICU) patients with Candida infection.
- Evaluate the yield of echocardiography, ophthalmologic examinations, brain imaging, and renal ultrasound (RUS) in diagnosing fungal dissemination.
Main Methods:
- Retrospective review of NICU patients with Candida-positive cultures (blood, urine, CSF, etc.) from 1997-2002.
- Data collected included patient demographics, risk factors, clinical symptoms, and results of ancillary investigations.
- Analysis focused on the occurrence, timing, and findings of echocardiograms, ophthalmologic exams, brain imaging, and RUS.
Main Results:
- Out of 66 neonates with Candida, 82% had echocardiograms, 55% had ophthalmologic exams, 76% had brain imaging, and 88% had RUS.
- No echocardiograms or ophthalmologic exams showed fungal involvement.
- Only one brain imaging study was positive; seven RUS studies had findings concerning for fungal involvement, but did not consistently alter therapy duration.
Conclusions:
- Ancillary tests for fungal dissemination in neonates with Candida infection were frequently performed but generally yielded limited information.
- While potentially valuable in specific cases, these investigations have a low overall diagnostic yield.
- Aggressive treatment protocols and a low threshold for suspicion may reduce the need for extensive ancillary testing.
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