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Epidemiology of Invasive Fungal Infections at Two Tertiary Care Neonatal Intensive Care Units Over a 12-Year Period

Roshani R Agarwal1,2, Rajkumar L Agarwal1,2, Xinguang Chen2

  • 1Children's Hospital of Michigan, Detroit, MI, USA.

Global Pediatric Health
|May 12, 2017
PubMed

Insights

Extremely low birth weight infants and Candida albicans infections are linked to poor Candida bloodstream infection (BSI) clearance. However, BSI clearance rates improved significantly from 2006-2011.

Area of Science:

  • Neonatal Intensive Care Medicine
  • Infectious Diseases
  • Mycology

Background:

  • Invasive fungal infections pose a significant threat to neonates, particularly in intensive care settings.
  • Candida bloodstream infections (BSI) are a major concern in neonatal intensive care units (NICUs).
  • Understanding trends and risk factors for Candida BSI is crucial for improving patient outcomes.

Purpose of the Study:

  • To analyze the incidence, species distribution, and clearance rates of Candida bloodstream infections (BSI) in a neonatal intensive care unit (NICU) over a 12-year period.
  • To identify factors associated with the non-clearance of Candida BSI in neonates.
  • To evaluate changes in treatment strategies and their impact on BSI outcomes.

Main Methods:

  • Retrospective review of 168 patients with invasive fungal infections from January 2000 to December 2011 in two NICUs.
  • Detailed analysis of 152 patients diagnosed with Candida bloodstream infection (BSI).
  • Comparison of clearance rates, species distribution, and treatment modalities between different patient groups and time periods.

Main Results:

  • Candida albicans was the most frequent species (47%), but non-albicans species increased from 2006-2011.
  • Lower Candida BSI clearance rates were observed in extremely low birth weight infants (77%) and those with C. albicans infections (77%).
  • Clearance rates improved significantly from 2000-2005 (70%-90%) to 2006-2011 (86%-100%), coinciding with increased combination antifungal use (73% vs 49%).

Conclusions:

  • Extremely low birth weight and C. albicans infection are significant risk factors for persistent Candida BSI.
  • Improved Candida BSI clearance rates in recent years may be attributed to the rise of non-albicans species and the increased use of combination antifungal therapy.
  • These findings highlight the evolving landscape of neonatal candidiasis and the need for tailored treatment approaches.
Keywords:
CandidaNICUclearancedisseminationinvasive fungal infections

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