Breakthrough fungaemia in neonates and infants caused by Candida albicans and Candida parapsilosis susceptible to fluconazole in vitro

Abstract

Breakthrough fungaemias due to Candida albicans and Candida parapsilosis appearing during fluconazole therapy in neonates and infants were assessed for risk factors and outcome. Forty fungaemias occurred during therapy with fluconazole within a 12 year national survey and were compared with 161 cases of non-breakthrough paediatric fungaemias. The agar disc diffusion test method was used for antifungal susceptibility testing and the Vitek system for species identification. Univariate and multivariate analysis for risk factors for breakthrough fungaemia were carried out. All the fungaemias were a result of strains susceptible to fluconazole at 0.25-4 mg/L in vitro [C. albicans (85%) and C. parapsilosis (15%)]. The mean number of positive blood cultures per episode was 2.2. Sixteen children had 'early' breakthrough fungaemias (within 4-5 days) and 24 fungaemias appeared on day 6 and later. Mean fluconazole MICs in the 'early' group were 1.2, and 2.8 mg/L in the 'late' group (P < 0.03, t-test). However, no difference was observed in the average dose of fluconazole used in the two groups. Neonatal age, total parenteral nutrition, very low birth weight, before surgery, central or umbilical venous catheterization and artificial ventilation were all significantly related to breakthrough fungaemia in univariate analysis but only central or umbilical venous catheterization were significant in multivariate analysis. The outcome of breakthrough fungaemia was better overall and attributable mortalities in non-breakthrough fungaemia was significantly higher in comparison with breakthrough fungaemia.

Breakthrough Candida Infection in a Preterm Infant with Congenital CutaneousCandida albicansInfection

“…Only one report described breakthrough candidemia in infants younger than 1 year of age. 9 All of the episodes occurred during fluconazole treatment: 100% of the infants had central or umbilical venous catheter, 85% were ventilated, 95% were treated with antibiotics, and 87% had received total parenteral nutrition prior to breakthrough infection. Eighty-five percent of the isolates were Candida albicans and the rest were Candida parapsilosis.…”

“…8 Persistent candidemia is common in VLBW infants, but breakthrough candidemia was not reported in neonates either during amphotericin B or liposomal amphotericin B (AmBisome; Nextar, Inc., USA) treatment. 9 In this article we describe a VLBW infant with congenital cutaneous candida (CCC) infection, who developed two episodes of breakthrough Candida bacteremia, while treated initially with amphotericin B and then with AmBisome.…”

Candida, still number one – what do we know and where are we going from there?

“…Candida parapsilosis , an additional emerging NAC is involved in bloodstream infections (BSI), particularly in neonates, 6 intensive care units or under parental nutrition, and is associated with catheter‐related infections. In a survey conducted in the US involving six neonatal intensive care units, C. parapsilosis was isolated from 29% Candida BSI 7 .…”

314 Healthcare-Associated Infections in Pediatrics

“…Earlier studies have also reported C. parapsilosis to cause candidemia during fluconazole prophylaxis, and some of those C. parapsilosis strains were reported to be less susceptible to fluconazole [257,258].…”