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First Case of Candida auris Colonization in a Preterm, Extremely Low-Birth-Weight Newborn after Vaginal Delivery
Alessio Mesini1, Carolina Saffioti1, Marcello Mariani1
1Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Largo G. Gaslini, 5, 16147 Genova, Italy.
Abstract:
Candida auris is a multidrug-resistant, difficult-to-eradicate pathogen that can colonize patients and health-care environments and cause severe infections and nosocomial outbreaks, especially in intensive care units. We observed an extremely low-birth-weight (800 g), preterm neonate born from vaginal delivery from a C. auris colonized mother, who was colonized by C. auris within a few hours after birth. We could not discriminate whether the colonization route was the birth canal or the intensive care unit environment. The infant died on her third day of life because of complications related to prematurity, without signs or symptoms of infections. In contexts with high rates of C.auris colonization, antifungal prophylaxis in low-birth-weight, preterm neonates with micafungin should be considered over fluconazole due to the C. auris resistance profile, at least until its presence is excluded.
Insights
A preterm infant born to a mother colonized with Candida auris acquired colonization shortly after birth. Antifungal prophylaxis with micafungin is recommended for high-risk neonates due to C. auris resistance patterns.
Area of Science:
- Infectious Diseases
- Neonatal Medicine
- Microbiology
Background:
- Candida auris is a multidrug-resistant pathogen causing severe infections and outbreaks, particularly in intensive care units.
- Neonates, especially those with extremely low birth weight and prematurity, are vulnerable to C. auris colonization and infection.
Observation:
- An extremely low-birth-weight, preterm neonate born via vaginal delivery to a C. auris colonized mother was observed.
- The neonate became colonized with C. auris within hours of birth.
- The exact route of colonization (birth canal or ICU environment) could not be determined.
Findings:
- The infant succumbed to complications of prematurity on day three, without signs of C. auris infection.
- This case highlights rapid C. auris colonization in a vulnerable preterm neonate.
- The study underscores the challenges in preventing neonatal colonization in high-prevalence environments.
Implications:
- In areas with high C. auris prevalence, consider micafungin over fluconazole for antifungal prophylaxis in low-birth-weight, preterm neonates.
- This recommendation is advised until C. auris colonization is definitively excluded.
- Early and targeted antifungal strategies may be crucial for improving outcomes in high-risk neonates.
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