Association of fungal colonization and invasive disease in very low birth weight infants

Huang, Yhu Chering; Li, Chung Chen; Lin, Tzou Yien; Lien, Rey In; Chou, Yi‐Hong; Wu, Jun; Hsueh, Chuen

doi:10.1097/00006454-199809000-00014

Cited by 119 publications

(80 citation statements)

References 6 publications

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“…There were no significant differences at the baseline between groups A and B in terms of presence of major (including antenatal) risk factors for fungal colonization and systemic infection, as defined by most reports. [1][2][3][4][5][6][7][8][9][10] Mean birth weight was significantly lower in group B (1108 vs 1212 g; P ϭ .001), in keeping with the tendency to admit more complicated pregnancies and deliveries to our department. For confirming the importance of the results, the a posteriori power for subgroup analysis was .97 in the ELBW group and .11 for the NE/VLBW group.…”

Section: Populationmentioning

confidence: 70%

“…It is important to remember that colonization by fungi is undoubtedly the most significant risk factor for the development of SFI in any patient, including preterm neonates, 6,7,10 and always precedes an SFI episode. 31,[38][39][40] Baley et al 6 in 1986 calculated that among 100 VLBW neonates in the NICU, 33 developed fungal colonization and 7 progressed to SFI.…”

Section: Discussionmentioning

confidence: 99%

“…Colonization by Candida species, multiple courses of antibiotics, parenteral nutrition, the presence of a central venous catheter, and the use of histamine receptor subtype 2 antagonists are most frequently associated with an increased risk for SFI. [4][5][6][7][8][9][10] Candida species is the third most frequent causal agent of late-onset sepsis (LOS) in preterm neonates, [1][2][3] with an estimated incidence of 1.6% to 9% in very low birth weight (VLBW) 2,4 and of 10% to 16% in extremely low birth weight (ELBW) neonates in the NICU 5,11 and a crude mortality of 30% to 75%. 1,5 These estimates may be too low, because diagnosis is hampered by the nonspecificity of clinical symptoms, the frequent unavailability of Candida isolates from blood cultures (their sensitivity for fungi may be as low as 50% 12,13 ), and poor sensitivity of the serum inflammatory markers.…”

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confidence: 99%

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Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study

Manzoni

Arisio²,

Mostert³

et al. 2006

Pediatrics

140

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OBJECTIVE. Despite the promising preliminary results observed in extremely low birth weight (ELBW) populations, the use of fluconazole to prevent fungal colonization and infection in preterm neonates in the NICU is still an open question and not yet recommended as a standard of care. We have reviewed our 6-year series to assess the effectiveness and safety of this form of prophylaxis.METHODS. This retrospective study consisted of 465 neonates who weighed Ͻ1500 g at birth and were admitted to our NICU in the period 1998 -2003. Those who were born between 1998 and 2000 and did not receive fluconazole prophylaxis (group A, n ϭ 240) were compared with those who were born between 2001 and 2003 and treated with fluconazole until the 30th day of life (45th for neonates Ͻ1000 g at birth; group B, n ϭ 225). Weekly surveillance cultures were obtained from all patients. Incidence of fungal colonization, incidence of systemic fungal infection (SFI), rate of progression from colonization to infection, and mortality rates attributable to fungi were calculated for both groups and separately for neonates who were Ͻ1000 g (ELBW) and were 1001 to 1500 g (NE-VLBW) at birth.RESULTS. Overall fungal colonization was significantly lower in group B (24.0%) than in group A (43.8%; relative risk [RR]: 0.406; 95% confidence interval [CI]: 0.273-0.605). The same was true of neonates with colonization in multiple sites (2.6% vs 5.8%) and of those with colonization from high-risk sites (5.8% vs 19.2%). SFI incidence was significantly lower in group B (10 of 225 cases; 4.4%) than in group A (40 of 240 cases; 16.7%; RR: 0.233; 95% CI: 0.113-0.447). Reduction of both colonization and SFI in group B was greater in the ELBW neonates and also significant in the NE-VLBW neonates. Rate of progression from colonization to infection was significantly lower in group B (0.17 vs 0.38; RR: 0.369; 95% CI: 0.159 -0.815). Crude mortality rate attributable to Candida species www.pediatrics.org/cgi

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Section: Populationmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study

Manzoni

Arisio²,

Mostert³

et al. 2006

Pediatrics

140

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“…El porcentaje de RNpret extremos colonizados que presentan una CI varía entre 7 y 28% en diferentes series 16,17 . Manzoni y cols., comunicaron una tasa de progresión a CI de 27,5%, en los pacientes colonizados por Candida spp en tres o más sitios versus 7,2% en aquellos RNpret extremos no colonizados (p < 0,001).…”

Section: Infectología Al Díaunclassified

Candidiasis invasoras en recién nacidos: diagnóstico, tratamiento y prevención

Izquierdo

Santolaya

2014

Rev. chil. infectol.

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“…A colonização pela Candida parapsilosis é mais tardia e parece ocorrer mais freqüentemente por via horizontal [7][8][9] .…”

Section: Fatores De Riscounclassified

Controversies about the management of invasive fungal infections in very low birth weight infants

Moreira¹

2005

J Pediatr (Rio J)

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Como citar este artigo: Moreira ME. Controvérsias a respeito da sepse fúngica no pré-termo extremo: profilaxia e esquemas terapêuticos. J Pediatr (Rio J). 2005;81(1 Supl):S52-S58. AbstractObjective: This review encompasses the most recent publications about fungal infection in very low birthweight infants, keeping health professionals updated about this growing problem observed in neonatal units. Sources of data:Original and review articles published over the past 15 years were searched in MEDLINE and Lilacs, using the following keywords: preterm infant, very low birthweight infants, sepsis, fungal infection, antifungal, Candida, amphotericin and fluconazole.Summary of the findings: Invasive fungal infections affect especially preterm infants. Although new drugs (echinocandins) to treat fungal infection are available, amphotericin is the most widely used drug for the treatment of systemic candidiasis at this stage of life. Currently, there are four types of antifungal agents used in the treatment of fungal infections in neonates: polyene macrolides (amphotericin B deoxycholate and lipid preparations), azoles (triazoles), fluorinated pyrimidines (flucytosine) and echinocandins (caspofungin and micafungin). Two drugs capable of preventing invasive fungal infection are described: nystatin and fluconazole. The pharmacokinetics of fluconazole in the neonatal period is widely known and its prophylactic administration during the first six weeks of life has been associated with less invasive fungal infection in infants weighing less than 1,000 g at birth.Conclusions: Fungal infections constitute an important problem in the neonatal intensive care unit and a better understanding of the incidence, diagnosis, clinical management, treatment, and prophylaxis is important in order to reduce morbidity and mortality. The identification of high-risk preterm infants and the implementation of prophylactic measures and early treatment may improve the outcome of these patients.J Pediatr (Rio J). 2005;81(1 Supl):S52-S58: Infection, very low birth weight infants, preterm infants, candida. ResumoObjetivo: Rever as mais recentes publicações sobre infecção fúngica no recém-nascido de muito baixo peso ao nascer, com objetivo de fornecer aos profissionais de saúde atualização sobre um crescente problema nas unidades neonatais. A revisão se dirige especificamente às questões relacionadas a incidência, manuseio clínico, tratamento e profilaxia. Fontes de dados:Artigos originais e de revisão, publicados nos últimos 15 anos no MEDLINE e Lilacs, foram identificados usando como palavras-chave: recém-nascido, prematuro, baixo peso ao nascer, infecção fúngica, sepse, cândida, anfotericina e fluconazol.Síntese dos dados: A incidência de sepse fúngica vem aumentando nas unidades de terapia intensiva neonatal. Embora novas drogas venham se tornando disponíveis (echinocandinas), a anfotericina B continua sendo a droga de escolha para o tratamento inicial. Atualmente, existem quatro classes de drogas disponíveis para o tratamento: os polienos macrolíde...

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Association of fungal colonization and invasive disease in very low birth weight infants

Abstract: Fungal colonization was detected in one-fifth of VLBW infants and represents a risk factor for fungemia. Because disease occurred in the absence of apparent colonization, factors other than colonization may contribute to invasive candidiasis.

Cited by 119 publications

References 6 publications

Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study

Prophylactic Fluconazole Is Effective in Preventing Fungal Colonization and Fungal Systemic Infections in Preterm Neonates: A Single-Center, 6-Year, Retrospective Cohort Study

Candidiasis invasoras en recién nacidos: diagnóstico, tratamiento y prevención

Controversies about the management of invasive fungal infections in very low birth weight infants

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