A Study of the Incidence and Outcome of Fungal Infections in the Neonatal Intensive Care Units; A Seven-year Surveillance Fungal Infections in NICU
Journal of Pediatric Nephrology,
Vol. 12 No. 1 (2024),
10 April 2025
https://doi.org/10.22037/jpn.v12i1.46525
Abstract
Background and Aim: Candida infections are rare in the neonatal period, but they are an
important cause of morbidity and mortality in neonatal intensive care units. Invasive fungal
infections are extremely difficult to diagnose. It is suggested to start empirical treatment
with antifungal therapy in high-risk, low-birth-weight infants who do not respond rapidly to
antibacterial therapy or in those who are in a septic state due to an unknown source, based
on regional guidelines. The aim of this study was to facilitate the earlier detection of at-risk
newborns to initiate antifungal therapy as soon as possible, thereby lowering mortality rates
and serious permanent disabilities.
Methods: This is a retrospective cross-sectional observational study on newborns admitted
to the neonatal intensive care unit (NICU) from March 2010 to February 2016. Risk factors,
such as birth weight, sex, route of delivery, the timing of oral feeding, total parental nutrition
(TPN), prescribed drugs (such as antibiotics, H2 blockers, methylxanthine, vasopressors, and
corticosteroids), underlying diseases, history of surgery, urinary catheter insertion, central
venous catheterization, and mechanical ventilation were extracted from patients’ files. Also,
we analyzed the blood groups of patients to find any possible relation to fungal infections.
Results: During the seven-year period, 2927 newborns were admitted to the NICU, of whom
32 patients (1.1%) were infected by fungal microorganisms. All but one of these neonates
were infected by C. albicans. Most of them had positive urine or blood cultures for C.
albicans (48.8% and 27.9%, respectively). All of our patients received amphotericin B as
standard therapy, resulting in a 75% recovery rate.
Conclusion: Surveillance of newborns with underlying risk factors aids in early decisionmaking
to start treatment for fungal infections in high-risk groups, thereby decreasing
mortality rates and long-term devastating complications.
- Blood culture
- Candida
- Candida albicans
- Fungal infection
- Neonate
- Neonatal intensive care unit
How to Cite
References
Kaufman DA, Manzoni P. Perinatal fungal and protozoal
infections. in: Martin RJ, Fanaroff AA, Walsh MC, editors.
Fanaroff & Martin’s neonatal-perinatal medicine: Diseases
of the fetus and infant. 10th Edition. Mosby Inc; Louis, USA:
Elsevier; 2011. [Link]
Rao S, Ali U. Systemic fungal infections in neonates. J Postgrad
Med. 2005;51(suppl 1):s27-9. [Link]
Ariff S, Saleem AF, Soofi SB, Sajjad R. Clinical spectrum and
outcomes of neonatal candidiasis in a tertiary care hospital
in Karachi, Pakistan. J Infect Dev Ctries. 2011; 5(3):216-23.
[DOI:10.3855/jidc.1232] [PMID]
Benjamin DK Jr, 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.
; 117(1):84-92. [DOI:10.1542/peds.2004-2292] [PMID]
Saiman L, Ludington E, Pfaller M, Rangel-Frausto S, Wiblin
RT, Dawson J, 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(4):319-
[DOI:10.1097/00006454-200004000-00011] [PMID]
Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen
P, Isolauri E. Probiotics in primary prevention of atopic disease:
A randomised placebo-controlled trial. Lancet. 2001;
(9262):1076-9. [DOI:10.1016/S0140-6736(00)04259-8]
[PMID]
Filioti I, Iosifidis E, Roilides E. Therapeutic strategies for
invasive fungal infections in neonatal and pediatric patients.
Expert Opin Pharmacother. 2008; 9(18):3179-96.
[DOI:10.1517/14656560802560005] [PMID]
Cahan H, Deville JG. Outcomes of neonatal candidiasis: The
impact of delayed initiation of antifungal therapy. Int J Pediatr.
; 2011:813871. [DOI:10.1155/2011/813871] [PMID]
Schelonka RL, Moser SA. Time to positive culture results
in neonatal Candida septicemia. J Pediatr. 2003; 142(5):564-5.
[DOI:10.1067/mpd.2003.188] [PMID]
Fisher JF, Sobel JD, Kauffman CA, Newman CA. Candida
urinary tract infections--treatment. Clin Infect Dis. 2011;
(Suppl 6):S457-66. [DOI:10.1093/cid/cir112] [PMID]
Sobel JD, Fisher JF, Kauffman CA, Newman CA. Candida
urinary tract infections--epidemiology. Clin Infect Dis. 2011;
(Suppl 6):S433-6. [DOI:10.1093/cid/cir109] [PMID]
Basu S, Kumar R, Tilak R, Kumar A. Candida blood stream
infection in neonates: Experience from A tertiary care teaching
hospital of central India. Indian Pediatr. 2017; 54(7):556-9.
[DOI:10.1007/s13312-017-1067-5] [PMID]
Baptista MI, Nona J, Ferreira M, Sampaio I, Abrantes M,
Tomé MT, et al. Invasive fungal infection in neonatal intensive
care units: A multicenter survey. J Chemother. 2016;
(1):37-43. [DOI:10.1179/1973947814Y.0000000222] [PMID]
Garzillo C, Bagattini M, Bogdanović L, Di Popolo A, Iula
VD, Catania MR, et al. Risk factors for Candida parapsilosis
bloodstream infection in a neonatal intensive care unit: A
case-control study. Ital J Pediatr. 2017; 43(1):10. [DOI:10.1186/
s13052-017-0332-5] [PMID]
Almooosa Z, Ahmed GY, Omran A, AlSarheed A, Alturki
A, Alaqeel A, et al. Invasive candidiasis in pediatric patients
at King Fahad Medical City in central Saudi Arabia. A
-year retrospective study. Saudi Med J. 2017; 38(11):1118-24.
[DOI:10.15537/smj.2017.11.21116] [PMID]
Leibovitz E, Livshiz-Riven I, Borer A, Taraboulos-Klein T,
Zamir O, Shany E, et al. A prospective study of the patterns
and dynamics of colonization with Candida spp. in very low
birth weight neonates. Scand J Infect Dis. 2013; 45(11):842-8.
[DOI:10.3109/00365548.2013.814150] [PMID]
Almirante B, Rodríguez D, Cuenca-Estrella M, Almela
M, Sanchez F, Ayats J, et al. Epidemiology, risk factors, and
prognosis of Candida parapsilosis bloodstream infections:
case-control population-based surveillance study of patients
in Barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2006;
(5):1681-5. [DOI:10.1128/JCM.44.5.1681-1685.2006] [PMID]
Kuhn DM, Mikherjee PK, Clark TA, Pujol C, Chandra
J, Hajjeh RA, et al. Candida parapsilosis characterization in
an outbreak setting. Emerg Infect Dis. 2004; 10(6):1074-81.
[DOI:10.3201/eid1006.030873] [PMID]
Clark TA, Slavinski SA, Morgan J, Lott T, Arthington-
Skaggs BA, Brandt ME, et al. Epidemiologic and molecular
characterization of an outbreak of Candida parapsilosis
bloodstream infections in a community hospital. J Clin Microbiol.
; 42(10):4468-72. [DOI:10.1128/JCM.42.10.4468-
2004] [PMID]
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance
definition of health care-associated infection and
criteria for specific types of infections in the acute care setting.
Am J Infect Control. 2008; 36(5):309-32. [DOI:10.1016/j.
ajic.2008.03.002] [PMID]
Steinbach WJ. Pediatric invasive candidiasis: Epidemiology
and diagnosis in children. J Fungi. 2016; 2(1):5. [DOI:10.3390/
jof2010005] [PMID]
Sarvikivi E, Lyytikäinen O, Soll DR, Pujol C, Pfaller MA,
Richardson M, et al. Emergence of fluconazole resistance in
a Candida parapsilosis strain that caused infections in a neonatal
intensive care unit. J Clin Microbiol. 2005; 43(6):2729-35.
[DOI:10.1128/JCM.43.6.2729-2735.2005] [PMID]
Chen J, Jiang Y, Wei B, Ding Y, Xu S, Qin P, et al. Epidemiology
of and risk factors for neonatal candidemia at a tertiary
care hospital in western China. BMC Infect Dis. 2016;
(1):700. [DOI:10.1186/s12879-016-2042-9] [PMID]
Kaufman DA. Challenging issues in neonatal candidiasis.
Curr Med Res Opin. 2010; 26(7):1769-78. [DOI:10.1185/03007
2010.487799] [PMID]
Fu J, Ding Y, Wei B, Wang L, Xu S, Qin P, et al. Epidemiology
of Candida albicans and non-C.albicans of neonatal candidemia
at a tertiary care hospital in western China. BMC Infect
Dis. 2017; 17(1):329. [DOI:10.1186/s12879-017-2423-8] [PMID]
Kelly MS, Benjamin DK Jr, Smith PB. The epidemiology
and diagnosis of invasive candidiasis among premature infants.
Clin Perinatol. 2015; 42(1):105-17. [DOI:10.1016/j.
clp.2014.10.008] [PMID]
Polin RA, Denson S, Brady MT; Committee on Fetus and
Newborn; Committee on Infectious Diseases. Epidemiology
and diagnosis of health care-associated infections in
the NICU. Pediatrics. 2012; 129(4):e1104-9. [DOI:10.1542/
peds.2012-0147] [PMID]
Pourfathollah A, Oody A, Honarkaran N. [Geographical
distribution of ABO and Rh (D) blood groups among Iranian
blood donors in the year 1361(1982) as compared with that
of the year 1380 (2001) (Persian)]. Sci J Iran Blood Transfus
Organ. 2004; 1(1):11-7. [Link]
Ben-Aryeh H, Blumfield E, Szargel R, Laufer D, Berdicevsky
I. Oral Candida carriage and blood group antigen
secretor status. Mycoses. 1995; 38(9-10):355-8.
[DOI:10.1111/j.1439-0507.1995.tb00064.x] [PMID]
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.
[DOI:10.1542/peds.2009-3412] [PMID]
Hooven TA, Polin RA. Healthcare-associated infections
in the hospitalized neonate: A review. Early Hum Dev.
; 90(Suppl 1):S4-6. [DOI:10.1016/S0378-3782(14)70002-7]
[PMID]
Sharifi
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