Invasive Fungal Infections in the Neonatal Intensive Care Unit

Background Due to the great burden of morbidity and mortality, invasive fungal infections (IFIs) are a major concern in neonatal intensive care units (NICUs) worldwide. This study aimed to evaluate the epidemiological and clinical characteristics, type of pathogen, risk factors, laboratory parameters, treatment, and clinical outcome associated with IFIs in a NICU within a three-year period. Methodology This study was conducted at the NICU, Pediatric Clinic, Clinical Centre of the University of Sarajevo from January 2020 to December 2022. A total of 22 infants were diagnosed with IFIs. Clinical data of the infants were collected from medical histories, including gestational age, gender, birth weight, perinatal conditions, major diseases, type and site of fungal isolate, time of onset of infection, clinical and laboratory findings, antifungal prophylaxis, antifungal therapy, broad-spectrum antibiotic therapy, clinical interventions, associated bacterial sepsis, total duration of hospitalization, and clinical outcomes. The study was approved by the Ethics Committee of Sarajevo University, Faculty of Medicine, Clinical Center University of Sarajevo. All cultures were monitored using an automated culture system. Passages to blood agar and Sabouraud dextrose agar were performed. Absolute numbers and percentages were used to describe categorical data, and median and interquartile ranges were used to describe numerical data due to data distribution that deviated from normal. The chi-square test or Fisher's exact test was used to analyze differences in categorical variables. The Mann-Whitney U-test and the Wilcoxon signed-rank test were used to analyze the differences in numerical variables between the observed groups. P-values <0.05 were considered statistically significant. Statistical analyses were performed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Results Between January 2020 and December 2022, a total of 22 infants had IFIs in the NICU, with an overall incidence of 11.5 per 1,000 admissions per year. Candida albicans was the most frequently isolated species (54.5%). The most important risk factors for IFIs in the NICU were long-term use of broad-spectrum antibiotics, parenteral nutrition, central venous catheter (CVC), mechanical ventilation (MV), birth weight <1,500 g, and prematurity. A significant increase in the median C-reactive protein and a decrease in the median platelet count was recorded between admission and the time of pathogen isolation. The overall mortality rate was 27.3% with significantly higher mortality in patients with C. albicans compared to other Candida species. Conclusions In this study, C. albicans was the most frequent causative agent of IFI (54.5%). The most important risk factors for IFIs in the NICU were long-term use of broad-spectrum antibiotics, parenteral nutrition, CVC, MV, birth weight <1,500 g, and prematurity. The mortality rate was significantly higher in patients infected with C. albicans than with non-albicans species.