Systemic Candidiasis in Neonatal Intensive Care Unit : A 8-Year Experience

Kim, Do Hyeon; Lee, Jin A; Jo, Heui Seung; Park, Kyung Ran; Park, June Dong; Kim, Beyong Il; Choi, Jung Hwan

Abstract

PURPOSE: Recently, Candida has become an increasingly significant neonatal pathogen, and may result in serious morbidity and mortality in the neonatal intensive care units. The purpose of this study was to describe and analyze our 8-year experiences with a review of the related literature, and to contribute to the improvement of the survival rate in the neonatal intensive care unit.
METHODS
We retrospectively reviewed the medical records of 20 patients who were diagnosed as systemic candidiasis in the neonatal intensive care unit of Seoul National University Children's Hospital between January 1993 and December 2000. We then analyzed demographics, clinical presentations, diagnostic features, risk factors, antifungal therapy, and outcomes.
RESULTS
Twenty-one systemic candidial infections occurred in 20 patients representing 0.85% of all NICU patients during the study period, among which 13 were very low birth weight (VLBW) infants (2.85% of total 456 VLBW infants). The mean gestational age and birth weight were 30.4 weeks and 1,430 gm, respectively. The common Candida species were C. albicans (61.9%), C. parapsilosis (38.1%), and the others such as C. glabrata (4.8%), C. tropicalis (4.8%), and C. famata (4.8%). The rates of culture positivity of blood, urine, and tracheal aspirates were 95.2%, 42.9%, and 9.5%, respectively. Each of candidial endocarditis, peritonitis, and renal fungus ball developed in a different patient. The most common presenting clinical signs were respiratory deterioration, abdominal distension, and apnea/bradycardia. All patients were treated with amphotericin B, alone in 9 cases or in combination with 5-flucytosine (7 cases) and with fluconazole (4 cases). Systemic candidiasis contributed to the deaths of 6 patients (30%).
CONCLUSION
In the neonatal intensive care unit of Seoul National University Children's Hospital, systemic candidiasis was a serious infection associated with high mortality and the diverse clinical features. Early diagnosis and appropriate antifungal therapy, combined with the elimination of the risk factors, may guarantee lower morbidity and mortality in the neonatal systemic candidiasis.