J Korean Soc Neonatol.  2000 Nov;7(2):97-104.

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

• Cho YJ
• Lee SL
• Kim JS

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.

Keyword

Very low-birth-weight infants (VLBWI); Candidal sepsis

MeSH Terms

Age of Onset
Amphotericin B
Anti-Bacterial Agents
Apnea
Birth Weight
Bradycardia
Candida
Candida albicans
Catheters, Indwelling
Causality
Early Diagnosis
Epidemiology*
Fluconazole
Gestational Age
Humans
Infant*
Mortality
Parenteral Nutrition, Total
Respiration, Artificial
Sepsis*
Survival Rate
Thrombocytopenia
Amphotericin B
Anti-Bacterial Agents
Fluconazole