A Decade of Invasive Candida Infection in Neonates: A Retrospective Study at a Tertiary Neonatal Intensive Care Unit in Thailand (2008–2018) Invasive Candida Infection in Neonates
Main Article Content
Abstract
OBJECTIVE: To determine the epidemiology of invasive candida infection in the neonatal intensive care unit (NICU) at a tertiary care center in Thailand over 10 years.
METHODS: A retrospective descriptive study was conducted. Participants were enrolled from all neonates diagnosed with invasive candidiasis infection (ICI) in Vajira Hospital between 2008 and 2018. Demographic data, microbiological results, and neonatal outcomes were reviewed.
RESULTS: During the study period, 9,031 neonates were admitted to the NICU. A total of 14 neonates were diagnosed with ICI, giving a prevalence of 1.5 cases per 1,000 infants admitted to the level II and III NICU. The median (IQR) gestational age and birth weight were 28.5 weeks (27.0, 31.0) and 1,053 g (850.0, 1,586.5), respectively. In all, 10 (71.4%) and 8 (57.1%) neonates had positive blood and urine cultures, respectively. All infants had negative cerebrospinal fluid cultures. Among 14 neonates diagnosed with ICI, 7 (50.0%) neonates had positive cultures for Candida albicans. The overall mortality rate of neonates with ICI was 21.4%.
CONCLUSION: ICI exhibits a low incidence rate within Vajira Hospital. This occurrence is demonstrably associated with prematurity, extremely low birth weight infants, and a demonstrably high mortality rate.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110(2 Pt 1):285-91.
Benjamin DK, Stoll BJ, Fanaroff AA, McDonald SA, Oh W, Higgins RD, et al. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics 2006;117(1):84-92.
Benjamin DK, DeLong E, Cotten CM, Garges HP, Steinbach WJ, Clark RH. Mortality following blood culture in premature infants: increased with gram-negative bacteremia and candidemia, but not gram-positive bacteremia. J Perinatol 2004;24(3):175-80.
Hundalani S, Pammi M. Invasive fungal infections in newborns and current management strategies. Expert Rev Anti Infect Ther 2013;11(7):709-21.
Cotten CM, McDonald S, Stoll B, Goldberg RN, Poole K, Benjamin DK Jr. The association of third-generation cephalosporin use and invasive candidiasis in extremely low birth-weight infants. Pediatrics 2006;118(2):717-22.
Friedman S, Richardson SE, Jacobs SE, O’Brien K. Systemic candida infection in extremely low birth weight infants: short term morbidity and long term neurodevelopmental outcome. Pediatr Infect Dis J 2000;19(6):499-504.
Adams-Chapman I, Bann CM, Das A, Goldberg RN, Stoll BJ, Walsh MC, et al. Neurodevelopmental outcome of extremely low birth weight infants with Candida infection. J Pediatr 2013;163(4):961-7.
Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. Jama 2004;292(19):2357-65.
Benjamin DK Jr, Stoll BJ, Gantz MG, Walsh MC, Sánchez PJ, Das A, et al. Neonatal candidiasis: epidemiology, risk factors, and clinical judgment. Pediatrics 2010;126(4):e865-73.
Jantarabenjakul W, Yodkitudomying C, Chindamporn A, Suchartlikitwong P, Anugulruengkitt S, Pancharoen C, et al. Pediatric and neonatal invasive candidiasis: species distribution and mortality rate in a Thai tertiary care hospital. Pediatr Infect Dis J 2021;40(2):96-102.
Ezenwa BN, Oladele RO, Akintan PE, Fajolu IB, Oshun PO, Oduyebo OO, et al. Invasive candidiasis in a neonatal intensive care unit in Lagos, Nigeria. Niger Postgrad Med J 2017;24(3):150-4.
Warris A, Pana ZD, Oletto A, Lundin R, Castagnola E, Lehrnbecher T, et al. Etiology and outcome of candidemia in neonates and children in Europe: an 11-year multinational retrospective study. Pediatr Infect Dis J 2020;39(2):114-20.
Aliaga S, Clark RH, Laughon M, Walsh TJ, Hope WW, Benjamin DK, et al. Changes in the incidence of candidiasis in neonatal intensive care units. Pediatrics 2014;133(2):236-42.
Agarwal RR, Agarwal RL, Chen X, Lua JL, Ang JY. Epidemiology of invasive fungal infections at two tertiary care neonatal intensive care units over a 12-year period (2000-2011). Glob Pediatr Health 2017;4:2333794x17696684.
Xia H, Wu H, Xia S, Zhu X, Chen C, Qiu G, et al. Invasive candidiasis in preterm neonates in China: a retrospective study from 11 NICUS during 2009-2011. Pediatr Infect Dis J 2014;33(1):106-9.
Thatrimontrichai A, Janjindamai W, Dissaneevate S, Maneenil G, Srisintorn W. Prevalence, risk factors and outcomes of neonatal invasive fungal infection in southern Thailand (1989-2017). Southeast Asian J Trop Med Public Health 2020;51(3):288-96.
Benjamin DK Jr, DeLong ER, Steinbach WJ, Cotton CM, Walsh TJ, Clark RH. Empirical therapy for neonatal candidemia in very low birth weight infants. Pediatrics 2003;112(3 Pt 1):543-7.
Lee JH, Hornik CP, Benjamin DK Jr, Herring AH, Clark RH, Cohen-Wolkowiez M, et al. Risk factors for invasive candidiasis in infants >1500 g birth weight. Pediatr Infect Dis J 2013;32(3):222-6.
Yu Y, Du L, Yuan T, Zheng J, Chen A, Chen L, et al. Risk factors and clinical analysis for invasive fungal infection in neonatal intensive care unit patients. Am J Perinatol 2013;30(7):589-94.
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America. Clin Infect Dis 2016;62(4):e1-50.
Rodriguez D, Almirante B, Park BJ, Cuenca-Estrella M, Planes AM, Sanchez F, et al. Candidemia in neonatal intensive care units: Barcelona, Spain. Pediatr Infect Dis J 2006;25(3):224-9.
Caggiano G, Lovero G, De Giglio O, Barbuti G, Montagna O, Laforgia N, et al. Candidemia in the neonatal intensive care unit: a retrospective, observational survey and analysis of literature data. Biomed Res Int 2017;2017:7901763.
Robinson JA, Pham HD, Bloom BT, Wittler RR. Risk factors for persistent candidemia infection in a neonatal intensive care unit and its effect on mortality and length of hospitalization. J Perinatol 2012;32(8):621-5.
Kelly MS, Benjamin DK Jr, Smith PB. The epidemiology and diagnosis of invasive candidiasis among premature infants. Clin Perinatol 2015;42(1):105-17.
Chitnis AS, Magill SS, Edwards JR, Chiller TM, Fridkin SK, Lessa FC. Trends in Candida central line-associated bloodstream infections among NICUs, 1999-2009. Pediatrics 2012;130(1):e46-52.
Wu Z, Liu Y, Feng X, Liu Y, Wang S, Zhu X, et al. Candidemia: incidence rates, type of species, and risk factors at a tertiary care academic hospital in China. Int J Infect Dis 2014;22:4-8.
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(6):504-8.
Pammi M, Holland L, Butler G, Gacser A, Bliss JM. Candida parapsilosis is a significant neonatal pathogen: a systematic review and meta-analysis. Pediatr Infect Dis J 2013;32(5):e206-16.
Chow BD, Linden JR, Bliss JM. Candida parapsilosis and the neonate: epidemiology, virulence and host defense in a unique patient setting. Expert Rev Anti Infect Ther 2012;10(8):935-46.
Celebi S, Hacimustafaoglu M, Koksal N, Ozkan H, Cetinkaya M, Ener B. Neonatal candidiasis: results of an 8 year study. Pediatr Int 2012;54(3):341-9.
Ramage G, Saville SP, Thomas DP, López-Ribot JL. Candida biofilms: an update. Eukaryot Cell 2005;4(4):633-8.
Hornik CD, Bondi DS, Greene NM, Cober MP, John B. Review of fluconazole treatment and prophylaxis for invasive candidiasis in neonates. J Pediatr Pharmacol Ther 2021;26(2):115-22.
Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;48(5):503-35.