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Neonatal invasive fungal infection in England 2004-2010

C Oeser1, S Vergnano, R Naidoo

  • 1Paediatric Infectious Diseases Research Group, Clinical Sciences, St George's, University of London, London, UK.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|February 1, 2014
PubMed

Insights

Invasive fungal infections are most common in extremely low birthweight neonates. Antifungal prophylaxis is crucial for this high-risk group, with unit-specific strategies needed to optimize care.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Epidemiology

Background:

  • Invasive fungal infections (IFIs) disproportionately affect neonates, particularly those with low birthweight.
  • Neonatal IFIs pose a significant threat, necessitating a clear understanding of current epidemiological trends.

Purpose of the Study:

  • To describe the epidemiology of invasive neonatal fungal infections within a UK neonatal infection surveillance network.
  • To identify high-risk infant populations and common causative organisms.

Main Methods:

  • Prospective multicentre surveillance conducted across 14 UK neonatal units from 2004 to 2010.
  • Data collection via a web-based database and standardized pro forma for positive fungal blood/cerebrospinal fluid cultures.

Main Results:

  • Overall incidence of IFIs was 2.4/1000 neonatal unit admissions, peaking at 18.8/1000 for extreme low birthweight infants (<1000 g).
  • Candida albicans (69%) and Candida parapsilosis (20%) were the predominant pathogens. Attributable case fatality rate was 21%.
  • Common risk factors included central venous catheter use, parenteral nutrition, and prior antibiotic exposure. Only 33% received antifungal prophylaxis.

Conclusions:

  • Extreme low birthweight neonates are the primary population at risk for IFIs.
  • Antifungal prophylaxis should be strongly considered for this vulnerable group, with unit-specific decisions on implementation due to variable 'number needed to treat'.
  • Further research is required for optimal empiric and therapeutic antifungal strategies.
Keywords:
Candidaemiaepidemiologyfungalneonatalprophylaxis

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