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Review of 49 neonates with acquired fungal sepsis: further characterization.
MedLine Citation:
PMID:  11134435     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Neonatal acquired fungal sepsis (AFS) is a risky condition that warrants every effort for early diagnosis and management. METHODS: We retrospectively reviewed the medical charts of all 4445 neonatal intensive care unit (NICU) admissions in the past 10 years and detected 49 neonates with AFS. We then compared their data with those of 49 matched control neonates who did not have AFS. The following details were collected: gestational, perinatal and neonatal courses; bacterial sepsis; antibacterial therapy; laboratory and imaging investigations; and antifungal therapy and its complications. RESULTS: The incidence of AFS was.4 to 2 cases per 1000 live-births and 3.8% to 12.9% of very low birth weight (VLBW) infants. Compared with 1989 through 1992, between 1993 and 1995 the rate of AFS in VLBW neonates significantly increased (3. 8%-5.6% --> 9.6%-12.9%), along with a significant increase of NICU admission rate (369-410 --> 496-510 admissions/year). Compared with controls, AFS neonates had significantly longer hospitalizations, higher rates of mechanical ventilation, umbilical vein catheterization, and previous treatment with broad-spectrum antibacterial agents (amikacin, vancomycin, ceftazidime, or imipenem). At the onset of AFS, 42.8% of patients had hyperthermia and 40.9% had normal white blood cell count. Causative fungi were as follows: Candida albicans-42.8% of cases, Candida parapsilosis-26.5%, and Candida tropicalis-20.4%. Fungal dissemination was rare, complications of antifungal therapy were infrequent, and no deaths occurred. CONCLUSIONS: First, non-albicans Candida have become more frequent in neonatal AFS. Second, mechanical ventilation and antibacterial agents are significant risk factors for AFS. Third, hyperthermia is a frequent presenting sign of AFS. Fourth, a normal white blood cell count does not rule out AFS. Fifth, meningeal involvement in neonatal AFS should be ruled out before initiation of antifungal therapy. Sixth, the policy of empiric antifungal therapy for AFS should be considered on an individual NICU basis.newborn infant, fungal sepsis, clinical signs, risk factors.
Authors:
I R Makhoul; I Kassis; T Smolkin; A Tamir; P Sujov
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics     Volume:  107     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2001 Jan 
Date Detail:
Created Date:  2001-01-08     Completed Date:  2001-01-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  61-6     Citation Subset:  IM    
Affiliation:
Department of Neonatology, Rambam Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. makhoul@rambam.health.gov.il
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MeSH Terms
Descriptor/Qualifier:
Abdomen / ultrasonography
Age of Onset
Cross Infection / diagnosis*,  drug therapy,  epidemiology*
Echocardiography
Echoencephalography
Fever / etiology
Humans
Incidence
Infant, Newborn
Infant, Very Low Birth Weight
Intensive Care Units, Neonatal / statistics & numerical data
Israel
Kidney / ultrasonography
Length of Stay
Mycoses / complications,  diagnosis*,  drug therapy,  epidemiology*
Regression Analysis
Retina / pathology
Retrospective Studies
Risk Factors

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