ABSTRACT
BACKGROUND Candida species is one of the most common causes of bloodstream infections among neonates and accounts for 9-13% of such infections. Non-albicans Candida have emerged as important opportunistic pathogens, notably C. tropicalis, C. glabrata, C. parapsilosis and C. krusei. With the introduction of antifungal agents, the causes of Candida infections shifted from an almost complete dominance of Candida albicans to the common involvement of Candida glabrata and other non-albicans Candida species.METHODSThis prospective, microbiological observational study was conducted in a tertiary care hospital for one and a half years from July 2016 to December 2017. Blood samples of neonates collected into Bactec Peds Plus/F Culture vials of an automated blood culture system (Bactec 9120, Becton Dikinson, USA) from clinically suspected cases of neonatal septicaemia were subjected to culture. Detailed clinical history such as presence of respiratory distress, abdominal distension, lethargy, feed intolerance, failure to thrive, poor perfusion, history of convulsions, duration of NICU stay and antibiotic use was taken from the medical records. The Candida species isolated were identified using standard mycological techniques. RESULTSOut of the total 250 clinically suspected cases of neonatal septicaemia, fungal growth was positive in 30 (12%) cases. Candida albicans accounted for 10% and non albicans Candida accounted for 90% of the fungal isolates. Candida glabrata (73.33%) was the commonest species followed by Candida tropicalis (16.67%) and Candida albicans (10%). Failure to thrive (60%), lethargy (50%) and respiratory distress (30%) were the most common clinical presentations seen, followed by feed intolerance (26.67%), abdominal distension (13.33%) and fever (10%). Among the risk factors observed for neonatal candidemia, low birth weight (76.67%) and prematurity (73.33%) were commonest followed by broad spectrum antibiotic use (66.67%), total parenteral nutrition (53.3%), ventilator support (36.67%) and indwelling catheters (26.67%).CONCLUSIONSNon-albicans Candida has emerged as an important pathogen causing neonatal septicaemia. Fungal sepsis is more common among preterm, low birth weight infants, those with prolonged antibiotic use and those on total parenteral nutrition. Candida glabrata caused the highest number of cases of fungal septicaemia
ABSTRACT
La incidencia de candidemia en las unidades de cuidados intensivos neonatales ha aumentado considerablemente en la última década, debido al aumento en la supervivencia de los recién nacidos de bajo peso y a los cambios en los procedimientos diagnósticos y terapéuticos. Se vienen observando cambios a nivel de la epidemiología de estas infecciones con el aumento de aislamientos de especies de Candida no albicans y la habilidad de éstas para desarrollar resistencia a los antifúngicos. Se diseñó un estudio descripitivo, retrospectivo de corte transversal, cuyo objetivo fue determinar la frecuencia de candidemia en la UTIN y UCNN del HUC, en el período 2009-2012. Se realizó una revisión de los registros del laboratorio de micología del HUC, donde se escogieron los casos de recién nacidos hospitalizados en la UTIN y en la UCNN con resultado positivo para Candida spp. en al menos un hemocultivo entre el período de julio de 2009 y agosto 2012. Se incluyeron un total de 34 pacientes cuya media en edad gestacional fue de 33 semanas y 1735 g de peso al nacer. 15/34 requirieron cirugía, 32/34 neonatos recibieron nutrición parenteral, lo que representa 94.1%, así como también el 79.4 % necesitaron ventilación mecánica. 23/34 (67.6%) de los neonatos con candidemia recibieron antibióticos de amplio espectro por más de 21 días y la media de hospitalización fue de 43 días. La prevalencia en la UTIN fue de 1.2 %. La especie de Candida más aislada fue la C.parapsilosis con un 85.1%. Todas las cepas ensayadas fueron sensibles a caspofungina y anfotericina B; mientras que para fluconazol y voriconazol hubo un porcentaje de resistencia de 6.9% y 2.9% respectivamente. Se concluye que en la UTIN y en la UCNN del HUC la C.parapsilosis es la más frecuente y existen factores de riesgos que favorecen su aparición.
Candida spp. are increasingly important hospital-acquired pathogens in neonatal intensive care unit (NICU) patients in the last decade due to increased survival of low birth weight and changes in diagnostic and therapeutic procedures. Changes have been observed in the epidemiology of these infections with isolates increased Candida non albicans species and the ability to develop resistance to these antifungals. A retrospective, cross sectional, descriptive study was performed, whose objective was to determine the frequency of candidemia in the NICU and the HUC UCNN in 2009-2012. A review of the records of the HUC mycology laboratory, where cases were selected infants hospitalized in the NICU and the UCNN with at least one blood culture positive for Candida in the period between July 2009 and August 2012. 34 patients were enrolled with a mean weight of 1735 g, and a mean gestational age of 33 weeks; 180 required surgery. 15/34 required surgery, 32/34 infants receiving parenteral nutrition, which represents 94.1% and 79.4% mechanical ventilatory assistance. 23/34 (67.6%) of the neonates with candidemia received broad spectrum antibiotics for more than 21 days and the average hospital stay was 43 days. The prevalence in the NICU was 1.2%. Candida parapsilosis was the most frequent species isolated (85.1%).All isolates were caspofungin and amphotericin B susceptibles, while for voriconazole and fluconazole resistance percentage was 6.9% and 2.9% respectively. We conclude that in the NICU and the UCNN of HUC the C. parapsilosis is the specie most frequently involved and risk factors exist that favor its appearance.