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Published on: July 1, 2020
Healthcare-associated Candida infections in neonates: A clinical perspective on risk and outcome
Berfin Özgökçe Özmen1, Merve Türkegün Şengül2, Suna Özdem1
1Department of Pediatrics, Mersin City Education and Research Hospital, University of Health Sciences, Mersin, Turkey.
Insights
Healthcare-associated Candida bloodstream infections (HAIs) are a significant threat in neonatal intensive care units (NICUs), especially for premature infants. Enhanced infection control and antifungal stewardship are crucial to combat these serious infections.
Area of Science:
- Neonatology
- Infectious Diseases
- Mycology
Background:
- Healthcare-associated infections (HAIs) are a major cause of morbidity and mortality in neonatal intensive care units (NICUs).
- Candida species are common fungal pathogens in vulnerable neonates, particularly preterm and low birth weight infants.
- Understanding risk factors and resistance patterns is crucial for effective management.
Purpose of the Study:
- To investigate the incidence, risk factors, species distribution, antifungal resistance, and outcomes of Candida bloodstream infections (CBIs) in a tertiary NICU.
- To identify key predisposing factors and common Candida species in neonates with CBIs.
- To inform infection control strategies and antifungal stewardship.
Main Methods:
- Retrospective analysis of neonates admitted to a tertiary NICU from January 1, 2015, to December 31, 2023.
- Active surveillance for HAIs and identification of neonates with Candida-positive blood cultures.
- Analysis of demographic data, clinical risk factors, laboratory findings, species identification, antifungal susceptibility, and treatment outcomes.
Main Results:
- A total of 26 (0.28%) neonates developed Candida bloodstream infections out of 9065 admissions.
- The majority of infected infants were premature (84.6%) and low birth weight (80%), with significant risk factors including central venous catheter use (92.3%), total parenteral nutrition (96.2%), and broad-spectrum antibiotic exposure (88.4%).
- Candida parapsilosis (46.2%) and Candida albicans (42.3%) were the most common species; 15.4% exhibited fluconazole resistance. The overall mortality rate was 38.5%.
Conclusions:
- Candida bloodstream infections pose a severe threat in NICUs, particularly for extremely low birth weight and premature infants.
- Invasive procedures and parenteral nutrition are significant risk factors for these infections.
- High mortality rates and emerging antifungal resistance necessitate strengthened infection control and antifungal stewardship programs.
Abstract:
ObjectiveHealthcare-associated infections (HAIs) remain a major cause of morbidity and mortality in neonatal intensive care units (NICUs), particularly in preterm and low birth weight infants. Candida species are among the most frequently isolated fungal pathogens in this vulnerable population.Study DesignThis retrospective study was conducted in a tertiary NICU in Turkey between January 1, 2015, and December 31, 2023. Daily active surveillance was used to detect HAIs. Neonates with Candida-positive blood cultures were identified. Demographic characteristics, clinical risk factors, laboratory findings, and treatment outcomes were analyzed.ResultsAmong 9065 neonates admitted to the NICU during the 9-year study period, 26 (0.28%) developed Candida bloodstream infections. The majority of affected infants were premature (84.6%) and had a birth weight ≤2500 g (80%), with 30.8% weighing <1000 g. Predisposing risk factors included: central venous catheter use (92.3%), total parenteral nutrition (96.2%), and exposure to broad-spectrum antibiotics (88.4%). The most frequently isolated species were Candida parapsilosis (46.2%) and Candida albicans (42.3%), while fluconazole resistance was detected in 15.4% of isolates. The overall mortality rate was 38.5%. The median hospital stay was 14.5 days.ConclusionsCandida bloodstream infections are a serious complication in NICUs, particularly among extremely low birth weight and premature infants. Invasive procedures and parenteral nutrition remain major risk factors. The observed high mortality rate and resistance patterns underscore the need for enhanced infection control measures and antifungal stewardship programs in NICUs.
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