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Systemic candidiasis in very low-birth-weight infants (less than 1,500 grams)
Insights
Aggressive early treatment with amphotericin B and 5-flucytosine improved survival for premature infants with systemic candidiasis. This approach, combined with removing predisposing factors, offers better outcomes for invasive Candida infections in neonates.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Mycology
Background:
- Systemic Candida albicans infection poses a high mortality risk (54%) and morbidity (25%) in very premature infants.
- Previous literature highlights the severity of invasive candidiasis in extremely low birth weight neonates.
Purpose of the Study:
- To evaluate the efficacy of early, aggressive antifungal treatment in extremely premature infants with systemic candidiasis.
- To identify key management strategies and clinical characteristics of invasive candidiasis in this vulnerable population.
Main Methods:
- Retrospective review of five extremely premature infants (mean birth weight 829g) treated for systemic candidiasis.
- Analysis of these cases alongside 26 previously reported patients.
Main Results:
- All five infants survived with minimal sequelae following treatment with amphotericin B and 5-flucytosine.
- Disseminated candidiasis can occur without positive blood, CSF, or urine cultures.
- Meningitis and osteoarthritis are more frequent in premature infants with disseminated candidiasis.
- Premature infants tolerate amphotericin B and 5-flucytosine well.
Conclusions:
- Early and aggressive antifungal therapy, alongside removal of predisposing factors, significantly improves outcomes for systemic candidiasis in premature infants.
- Treatment should involve antifungal agents (amphotericin B and 5-flucytosine), removal of indwelling devices, and broad-spectrum antibiotics.
- Continuous vigilance and prompt intervention are crucial for managing invasive fungal infections in neonates.
Abstract:
Previous reports in the literature have documented that systemic infection with Candida albicans in very premature infants is frequently fatal (54%) or associated with significant morbidity in survivors (25%). Five patients with a mean birth weight of 829 g had a diagnosis of systemic candidiasis during their stay in a newborn intensive care unit. All infants survived with minimal sequelae following aggressive early treatment with amphotericin B and 5-flucytosine. A review of these five extremely premature infants and 26 previously reported patients suggests the following: (1) disseminated candidiasis is common in the absence of positive findings in blood, CSF, and/or urine cultures; (2) transient candidemia rarely resolves without therapy; (3) meningitis and osteoarthritis occur more frequently than in older patients with disseminated disease; and (4) premature infants tolerate amphotericin B and 5-flucytosine well. Infants who are found to have systemic cultures positive for candidiasis should be treated by (1) removing all factors that predispose to systemic candidiasis (eg, indwelling catheters, broad-spectrum antibiotics); (2) early initiation of systemic antifungal therapy with amphotericin B and 5-flucytosine; and (3) searching for additional foci of disease. After the disease is recognized and treatment is prompt and aggressive, outcome can be substantially improved.