Neonatal Invasive Candidiasis: A Prospective Multicenter Study of 118 Cases

José B. López Sastre; Gil D. Coto Cotallo; Belén Fernández Colomer; null Grupo de Hospitales Castrillo

doi:10.1055/s-2003-40008

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Am J Perinatol 2003; 20(3): 153-164
DOI: 10.1055/s-2003-40008

Neonatal Invasive Candidiasis: A Prospective Multicenter Study of 118 Cases

José B. López Sastre¹ , Gil D. Coto Cotallo¹ , Belén Fernández Colomer¹ , . Grupo de Hospitales Castrillo²

¹Service of Neonatology, Department of Pediatrics, Hospital Central de Asturias, Oviedo, Spain
²Members of Grupo de Hospitales Castrillo, Spain

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Publication Date:
12 June 2003 (online)

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ABSTRACT

A prospective multicenter study was conducted to assess the epidemiology of neonatal invasive candidiasis in Spain. In a total of 20,565 admissions to the 27 participating neonatal units over an 18-month period, systemic candidiasis was diagnosed in 118 (0.57%) neonates. Candida species were isolated from the blood in 79 infants, from the urine in 33, and from the cerebrospinal fluid in 4; in 2 cases, histologic evidence of deep tissue candidiasis was found at autopsy. Very-low-birth-weight (VLBW) infants (≤ 1500 g) showed a significantly higher incidence of systemic candidiasis (4.8%) than infants weighing > 1500 g (0.2%) (p < 0.001). Candida albicans was the most frequent species (52.5%) followed by C. parapsilosis (23.7%), and C. tropicalis (7.6%). Only seven infants were treated with amphotericin B (initial dose 0.18 ± 0.3 mg/kg, maximal daily dose 1.7 ± 0.9 mg/kg) but treatment was stopped in three of them (43%) due to nephrotoxicity. Liposomal amphotericin B was given to 81 neonates and amphotericin B lipid complex to 29. There were no differences in mortality rate and in the incidence of adverse effects in relation to treatment with liposomal amphotericin B or amphotericin B lipid complex. The mortality rate was 10.2% and all deaths occurred in the VLBW cohort with candidemia.

KEYWORDS

Invasive candidiasis - neonatal candidiasis - neonatal sepsis - Candida urinary tract infection - Candida albicans - Candida parapsilosis - liposomal amphotericin B - amphotericin B lipid complex

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