Prevention and Treatment of Candida Infections in Neonates
Section snippets
Epidemiology
The majority of fungal infections in the VLBW population are caused by C. albicans and C. parapsilosis, although almost all species of Candida have been implicated.20, 21, 22, 23 Epidemiologic studies have demonstrated that the pattern of transmission is most commonly vertical (from mother to infant) with C. albicans, and horizontal with C. parapsilosis (primarily in the presence of a central catheter).24, 25, 26, 27, 28 Bayley and colleagues first demonstrated the association between fungal
Diagnosis
Diagnosis of candidemia in this population is still primarily limited to standard blood culture, although the sensitivity of blood cultures for detection of Candida can be as low as 50% to 80%.41, 42 Recovery of Candida and/or a positive fungal smear from other normally sterile body fluids, such as urine and cerebrospinal fluid, also aids in the diagnosis. The use of other diagnostic testing methods, including biochemical markers, antigen assays, and polymerase chain reaction, is currently
Treatment
Despite the use of antifungal therapy, persistent infection, focal complications, and death are not uncommon sequelae of systemic Candida infections in premature neonates.17, 18, 19 In addition to pharmacologic treatment, prompt removal or replacement of any indwelling central catheter is recommended, if at all feasible.43 A small retrospective review of pediatric patients documented a significantly increased incidence of persistent candidemia, as well as a suggested increased risk of morality
Prevention
Difficulty with diagnosis and the persistence of significant morbidity and mortality despite antifungal agents have directed significant research efforts toward preventative strategies, including antifungal chemoprophylaxis. The wide variability in center-to-center reported rates of fungal infections suggest the potential relationship to center-specific practices. Standard preventative methods include strict hand washing, prompt removal of central catheters when no longer necessary, and prudent
Summary
Invasive Candida infections remain a significant cause of morbidity and mortality among the smallest infants in the neonatal intensive care unit. Improvement in diagnostic testing, further clinical investigation of the role of the newer generation azoles and echinocandins in the neonatal population, and well-designed multi-center trials of therapeutic and prophylactic pharmacologic agents as well as further delineations of best practices in infection control have significant potential for
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Cited by (45)
Maternal pregnancy-induced hypertension increases the subsequent risk of neonatal candidiasis: A nationwide population-based cohort study
2019, Taiwanese Journal of Obstetrics and GynecologyCitation Excerpt :Neonatal candidiasis has emerged as one of the leading cause of late-onset infection in most neonatal intensive care units and is associated with significant morbidity and mortality in the neonates. Neonatal candidiasis developed in 2.6%–16.7% of very low birth weight infants (VLBW, less than 1500 g) and 5.5%–20% of extremely low birth weight infants (ELBW, less than 1000 g) [6,9,10]. The crude mortality related to neonatal candida infection ranged from 10% to 54% [10–12].
Candida albicans outbreak associated with total parenteral nutrition in the neonatal unit
2016, Indian Journal of Medical MicrobiologyIntegrated measures for prevention of invasive Candida infections in preterm infants in a Chinese neonatal intensive care unit
2015, American Journal of Infection ControlPrevention of healthcare-associated infections in neonates: Room for improvement
2015, Journal of Hospital InfectionCitation Excerpt :Previous mucosal and skin colonization are the main risk factors for IFIs. Neonatal colonization with Candida spp. is secondary to either maternal transmission or nosocomial acquisition via healthcare workers' hands in the NICU.29 Candida albicans is the most prevalent fungal pathogen in neonatal disease.
Oral colonization: A possible source for candidemia in low-weight neonates
2014, Journal de Mycologie MedicaleCitation Excerpt :Studies have shown that the initial oral colonization takes place in the first 2 weeks of life. This is the period of time related to the establishment of fungal infections [9,26]. Colonization has been described as the main factor leading to the infection development, and may be present in neonates soon after the birth due to physical contact [14].