1. Abstract

Neonatal Candida infections are the leading cause of invasive fungal infections that might cause severe morbidity or mortality in a large majority of those affected. Although Candida albicans has been the most common species, Candida parapsilosis is increasingly being recognized as an important cause of invasive candidiasis in neonates. Among the Candida species, C. parapsilosis has been commonly isolated and shown to be less susceptible in vitro to echinocandins than other Candida species. We report an infant who had refractory C. parapsilosis septicemia cured with caspofungin.

PMID: 24567311 2. Abstract

BACKGROUND:

In neonatal intensive care unit (NICU) invasive fungal infections are predominantly supported by Candida species, with an increasing frequency of C. non-albicans. This work aims to demonstrate the need for monitoring of these infections for the purposes of a more effective prevention strategy.

METHODS:

This study, conducted for 15 months on 365 patients admitted to the NICU of the University Hospital "Federico II" of Naples, examines the colonization and nosocomial infections by Candida species in relation to the most significant risk factors such as prematurity, low birth weight and the application of relief devices.

RESULTS:

It was detected a statistically significant association between infections and pharyngeal colonization (p = 0.002), gestational age <28 weeks (p = 0.001) and central venous catheterization (p = 0.01). 12% of the 336 patients cared for more than 48 hours had pharyngeal colonization byCandida spp, especially C. albicans, while 2% develops sepsis due to C. parapsilosis.

CONCLUSIONS:

The results demonstrate the importance and validity of the procedures used for the surveillance of infections in NICU.

PMID: 23435781

3. Abstract

OBJECTIVE:

To explore the management of fungal pyelonephritis in infants.

METHOD:

Data from 5 cases with fungal pyelonephritis, including the clinical situation, laboratory examination, feature of imaging, and treatment were analyzed.

RESULT:

All the 5 cases were preterm and low birth weight infants. In 3 cases the disease was unilateral, in 2 cases were bilateral, and acute renal failure occurred. Fungus balls presented on imaging. Urine culture was positive of Candida albicans. Treatment with percutaneous nephrostomy, irrigation and antifungal agent were associated with good prognosis. Only 1 case died. The surviving patients were followed up for 10 - 20 months and the results showed normal growth and development. B-mode ultrasound examination did not show any malformation of the urinary system.

CONCLUSION:

Fungal pyelonephritis was commom in preterm infants. Candida albicans was the major pathogenic microorganism. Percutaneous nephrostomy and drainage were effective in patients with urinary obstruction in relief of obstruction, early diagnosis and control of infection.

PMID: 23324153

4. Abstract

OBJECTIVE:

In this study, we seek to determine independent risk factors of invasive fungal infection (IFI) in neonatal infants.

STUDY DESIGN:

The medical charts of 5135 neonatal intensive care unit admissions in the past 7 years between January 2004 and December 2010 were reviewed and 45 neonates were found with IFI. Two controls, matched by gestational age, birth weight category, admission date, ward, hospital stay, and admission age, were selected for each case.

RESULTS:

Candida parapsilosis was the leading causative pathogen of IFI and was isolated in 33.3% of the patients. The mortality rate of the case group was 8.9% versus 1.1% in controls (p < 0.05). Multivariable logistic regression modeling defined intubation > 6 days (71.1%), use of peripherally inserted central venous catheter (68.8%), use of third-generation cephalosporin (53.3%), any prior abdominal surgeries (20.0%), and neutropenia during first week of life < 1.5 · 109/L (20.0%) as exposures significantly associated with case status.

CONCLUSIONS:

The predominant factors identified with IFI were third-generation cephalosporin use, peripherally inserted central venous catheter use, intubation > 6 days, any prior abdominal surgery, and neutropenia during first week of life < 1.5 · 109/L.

PMID: 23277386