Epidemiology of fungal infections and risk factors in newborn patients

Paolo Manzoni

DOI: https://doi.org/10.7175/rhc.v4i1S.856

Abstract

The incidence of fungal infections among newborn babies is increasing, owing mainly to the in­creased ability to care and make survive immature infants at higher specific risk for fungal infections. The risk is higher in infants with very low and extremely low birth weight, in babies receiving total parenteral nutrition, in neonates with limited barrier effect in the gut, or with central venous catheter or other devices where fungal biofilms can originate. Also neonates receiving broad spectrum antibiotics, born through caesarian section or non-breastfed can feature an increased, specific risk. Most fungal infections in neonatology occur in premature children, are of nosocomial origin, and are due to Candida species. Colonization is a preliminary step, and some factors must be considered for the diagnosis and grading process: the iso­lation site, the number of colonized sites, the intensity of colonization, and the Candida subspecies. The most complicated patients are at greater risk of fungal infections, and prophylaxis or pre-emptive therapy should often be considered. A consistent decisional tree in neonatology is yet to be defined, but some efforts have been made in order to identify characteristics that should guide the prophylaxis or treatment choices. A negative blood culture and the absence of symptoms aren’t enough to rule out the diagnosis of fungal infections in newborn babies. Similarly, laboratory tests have been validated only for adults. The clinical judgement is of utmost importance in the diagnostic process, and should take into account the presence of clinical signs of infection, of a severe clinical deterioration, as well as changes in some laboratory tests, and also the presence and characteristics of a pre-existing fungal colonization.

Keywords

Fungal infections; Neonatology; Risk factors; Candida; Premature children; Colonization

Full Text:

HTML PDF

References

  • Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev 2004; 17: 638-80; http://dx.doi.org/10.1128/CMR.17.3.638-680.2004
  • Kossoff EH, Buescher ES, Karlowicz MG. Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases. Pediatr Infect Dis J 1998; 17: 504-8; http://dx.doi.org/10.1097/00006454-199806000-00014
  • Fridkin SK, Kaufman D, Edwards JR, et al. Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995-2004. Pediatrics 2006; 117: 1680-7; http://dx.doi.org/10.1542/peds.2005-1996
  • Manzoni P, Mostert M, Jacqz-Aigrain E, et al. The use of fluconazole in neonatal intensive care units. Arch Dis Child 2009; 94: 983-7; http://dx.doi.org/10.1136/adc.2008.154385
  • Saiman L, Ludington E, Pfaller M, et al. Risk factors for candidemia in Neonatal Intensive Care Unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J 2000; 19: 319-24; http://dx.doi.org/10.1097/00006454-200004000-00011
  • Kaufman D, Boyle R, Hazen KC, et al. Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N Engl J Med 2001; 345: 1660-6; http://dx.doi.org/10.1056/NEJMoa010494
  • Linder N, Levit O, Klinger G, et al. Risk factors associated with candidaemia in the neonatal intensive care unit: a case-control study. J Hosp Infect 2004; 57: 321-4; http://dx.doi.org/10.1016/j.jhin.2004.04.010
  • Kim AS, Garni RM, Henry-Stanley MJ, et al. Hypoxia and extraintestinal dissemination of Candida albicans yeast forms. Shock 2003; 19: 257-62; http://dx.doi.org/10.1097/00024382-200303000-00010
  • Bendel CM. Colonization and epithelial adhesion in the pathogenesis of neonatal candidiasis. Semin Perinatol 2003; 27: 357-64; http://dx.doi.org/10.1016/S0146-0005(03)00059-4
  • Chapman RL, Faix RG. Persistently positive cultures and outcome in invasive neonatal candidiasis. Pediatr Infect Dis J 2000; 19: 822-7; http://dx.doi.org/10.1097/00006454-200009000-00003
  • Fernandez M, Moylett EH, Noyola DE, et al. Candidal meningitis in neonates: a 10-year review. Clin Infect Dis 2000; 31: 458-63; http://dx.doi.org/10.1086/313973
  • Coates EW, Karlowicz MG, Croitoru DP, et al. Distinctive distribution of pathogens associated with peritonitis in neonates with focal intestinal perforation compared with necrotizing enterocolitis. Pediatrics 2005; 116: e241-6; http://dx.doi.org/10.1542/peds.2004-2537
  • Bianconi S, Gudavalli M, Sutija VG, et al. Ranitidine and late-onset sepsis in the NICU. J Perinat Med 2007; 35: 147-50; http://dx.doi.org/10.1515/JPM.2007.017
  • Hamosh M. Protective function of proteins and lipids in human milk. Biol Neonate 1998; 74: 163-76; http://dx.doi.org/10.1159/000014021
  • Buescher ES. Host defense mechanism of human milk and their relation to enteric infections and necrotizing enterocolitis. Clin Perinatol 1994; 21: 247-62
  • Goldman AS, Thorpe LW, Goldblum RM, et al. Antiinflammatory properties of human milk. Acta Paed Scand 1986; 75: 689; http://dx.doi.org/10.1111/j.1651-2227.1986.tb10275.x
  • Hylander MA, Strobino DM, Dhanireddy R. Human milk feeding and infection among very low birth weight infants. Pediatrics 1998; 102: E38; http://dx.doi.org/10.1542/peds.102.3.e38
  • Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 1999; 103: 1150-7; http://dx.doi.org/10.1542/peds.103.6.1150
  • Stoll BJ, Gordon T, Korones SB, et al. Early-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996; 129: 72-80; http://dx.doi.org/10.1016/S0022-3476(96)70192-0; http://dx.doi.org/10.1016/S0022-3476(96)70191-9
  • Kicklighter SD, Springer SC, Cox T, et al. Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant. Pediatrics 2001; 107: 293-8; http://dx.doi.org/10.1542/peds.107.2.293
  • Magill SS, Swoboda SM, Johnson EA, et al. The association between anatomic site of Candida colonization, invasive candidiasis, and mortality in critically ill surgical patients. Diagn Microbiol Infect Dis 2006; 55: 293-30; http://dx.doi.org/10.1016/j.diagmicrobio.2006.03.013
  • Agvald-Ohman C, Klingspor L, Hjelmqvist H, et al. Invasive candidiasis in long-term patients at a multidisciplinary intensive care unit: Candida colonization index, risk factors, treatment and outcome. Scand J Infect Dis 2008; 40: 145-53; http://dx.doi.org/10.1080/00365540701534509
  • Nobile CJ, Andes DR, Nett JE, et al. Critical role of Bcr1-dependent adhesins in C. albicans biofilm formation in vitro and in vivo. PLoS Pathog 2006; 2: e63; http://dx.doi.org/10.1371/journal.ppat.0020063
  • Kaufman DA, Gurka MJ, Hazen KC, et al. Patterns of fungal colonization in preterm infants weighing less than 1000 grams at birth. Pediatr Infect Dis J 2006; 25: 733-7; http://dx.doi.org/10.1097/01.inf.0000226978.96218.e6
  • Manzoni P, Farina D, Galletto P, et al. Type and number of sites colonized by fungi and risk of progression to invasive fungal infection in preterm neonates in neonatal intensive care unit. J Perinat Med 2007; 35: 220-6; http://dx.doi.org/10.1515/JPM.2007.055
  • El-Masry FA, Neal TJ, Subhedar NV. Risk factors for invasive fungal infection in neonates. Acta Paediatr 2002; 91: 198-202; http://dx.doi.org/10.1111/j.1651-2227.2002.tb01695.x
  • Manzoni P, Farina D, Leonessa M, et al. Risk factors for progression to invasive fungal infection in preterm neonates with fungal colonization. Pediatrics 2006; 118: 2359-64; http://dx.doi.org/10.1542/peds.2006-1311
  • Sandford GR, Merz WG, Wingard JR, et al. The value of fungal surveillance cultures as predictors of systemic fungal infections. J Infect Dis 1980; 142: 503-9; http://dx.doi.org/10.1093/infdis/142.4.503
  • Rowen JL, Rench MA, Kozinetz CA, et al. Endotracheal colonization with Candida enhances risk of systemic candidiasis in very low birth weight neonates. J Pediatr 1994; 124: 789-94; http://dx.doi.org/10.1016/S0022-3476(05)81375-7
  • Pittet D, Monod M, Suter PM, et al. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 1994; 220: 751-8; http://dx.doi.org/10.1097/00000658-199412000-00008
  • Safdar A, Armstrong D. Prospective evaluation of Candida species colonization in hospitalized cancer patients: impact on short-term survival in recipients of marrow transplantation and patients with hematological malignancies. Bone Marrow Transplant 2002; 30: 931-5; http://dx.doi.org/10.1038/sj.bmt.1703732
  • León C, Ruiz-Santana S, Saavedra P, et al; EPCAN Study Group. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 2006; 34: 730-7; http://dx.doi.org/10.1097/01.CCM.0000202208.37364.7D
  • Benjamin DK Jr, Stoll BJ, Fanaroff AA, et al; National Institute of Child Health and Human Development Neonatal Research Network. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics 2006; 117: 84-92; http://dx.doi.org/10.1542/peds.2004-2292
  • Khalid NH. Definitions of bloodstream infection in the newborn. Pediatr Crit Care Med 2005; 6 (Suppl.): S45-S49; http://dx.doi.org/10.1097/01.PCC.0000161946.73305.0A
  • Manzoni P, Castagnola E, Mostert M, et al. Hyperglycaemia as a possible marker of invasive fungal infection in preterm neonates. Acta Paediatr 2006; 95: 486-93; http://dx.doi.org/10.1080/08035250500444867; http://dx.doi.org/10.1111/j.1651-2227.2006.tb02266.x
  • Guida JD, Kunig AM, Leef KH, et al. Platelet count and sepsis in very low birth weight neonates: is there an organism-specific response? Pediatrics 2003; 111: 1411-5; http://dx.doi.org/10.1542/peds.111.6.1411
  • Benjamin DK Jr, DeLong ER, Steinbach WJ, et al. Empirical therapy for neonatal candidemia in very low birth weight infants. Pediatrics 2003; 112: 543-7; http://dx.doi.org/10.1542/peds.112.3.543
  • Benjamin DK Jr, Ross K, McKinney RE Jr, et al. When to suspect fungal infection in neonates: A clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia. Pediatrics 2000; 106: 712-8; http://dx.doi.org/10.1542/peds.106.4.712
  • Benjamin DK Jr, Ross K, McKinney RE Jr, et al. When to suspect fungal infection in neonates: A clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia. Pediatrics 2000; 106: 712-8; http://dx.doi.org/10.1542/peds.106.4.712
  • Manzoni P, Pedicino R, Stolfi I, et al; Task Force per le infezioni fungine neonatali del GSIN; Società Italiana di Neonatologia. Criteria for the diagnosis of systemic fungal infections in newborns: a report from the Task Force on neonatal fungal infections of the GSIN. Pediatr Med Chir 2004; 26: 89-95

Refbacks

  • There are currently no refbacks.




© SEEd srl