Candidal Sepsis in Very Low-Bith-Weight Infants: Clinical Manifestations and Epidemiology

ABSTRACT

PURPOSE: With a dramatic improvement in the survival rate of the very low-birth-weight (VLBW) infants, systemic fungal infections, especially candida sepsis, appear to represent an increasing problem among high risk neonatal patients. So, we evaluated epidemiological and clinical features of candidal sepsis in VLBW infants. METHODS: Among the VLBW infants who were admitted to NICU of the Dongsan Medical Center, Keimyung University between January 1996 and December 1999. Patients with candidal sepsis, which was proven by cultures, were evaluated for prediposing factors, clinical manifestations, and treatment and sequelae. RESULTS: 1) A total of 22 infants, representing 9.6% of the total admissions of infants with birth weight < 1,500 gram were diagnosed with candidal sepsis during hospitelizations. The mean gestational age was 29.5 weeks (27-36.3 weeks) and the mean birth weight was 1,260 gram (860-1,480 g). 2) The predisposing factors were long-term use of antibiotics, prolonged parenteral hyperalimentation with lipid, indwelling catheter, steroid treatment and mechanical ventilation. 3) The mean age of onset infection was 48 days. The most common presenting clinical manifestations were temperature instability (46.2%), apnea and/or bradycardia (42.3%), feeding intolerance (42.3%), and decreased activity (38.5%). The most common hematologic change was thrombocytopenia (53.9%). 4) The most frequent organism was Candida albicans (65.4%), following by species were C. tropicalis (11.5%), C. lusitaniae (7.7%) and C. parasilosis (7.7%). 5) After treatment of intravenous amphotericin B with or without diflucan, the mortality rate was 13.6% and significant complications were not noted. CONCLUSION: We reviewed the clinical spectrum of candidal sepsis in the VLBW infants in NICU, and concluded that early diagnosis and treatment may be important in improving the mortality and morbidity of VLBWI with candidal sepsis.