Invasive fungal infection in neonatal intensive care units: a multicenter survey

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Clinical Pharmacy

Background:

• Invasive fungal infections (IFI) pose a significant threat to neonates, particularly those in Neonatal Intensive Care Units (NICUs).
• Understanding the local epidemiology of IFI is crucial for developing effective prevention and treatment strategies in vulnerable infant populations.

Purpose of the Study:

• To assess the epidemiology of IFI in Portuguese NICUs between 2005 and 2010.
• To compare the effectiveness and safety of different antifungal therapies used in neonates.

Main Methods:

• A survey was conducted in NICUs of Greater Lisbon covering the period 2005-2010.
• Data collected included the incidence of IFI, causative fungal species, and details of antifungal treatments administered.
• Analysis focused on cumulative incidence, common isolates, initial and switched antifungal agents, and case fatality rates.

Main Results:

• A total of 44 cases of IFI were identified among 10,473 admitted neonates, with a cumulative incidence rate of 0.42%.
• Extreme low birth weight neonates accounted for the majority of cases (65.9%).
• Candida albicans and Candida parapsilosis were the most frequent isolates. Central vascular catheters were present in all IFI cases. Initial treatments included fluconazole (22 cases) and liposomal amphotericin B (L-AmB) (18 cases), with successful therapy switches in some patients. The case fatality rate was 11.4%. No serious adverse drug reactions were reported.

Conclusions:

• Local epidemiological data on IFI in Portuguese NICUs are essential for guiding prophylactic and treatment strategies.
• Fluconazole and L-AmB appear to be safe and effective initial treatments for neonatal IFI, though further comparative studies may be warranted.