The Epidemiology and Diagnosis of Invasive Candidiasis Among Premature Infants

The human gut microbiota is composed of bacteria (microbiota or microbiome), fungi (mycobiome), viruses, and archaea, but most of the research is primarily focused on the bacterial component of this ecosystem. Besides bacteria, fungi have been shown to play a role in host health and physiologic functions. However, studies on mycobiota composition during infancy, the factors that might shape infant gut mycobiota, and implications to child health and development are limited. In this review, we discuss the factors likely shaping gut mycobiota, interkingdom interactions, and associations with child health outcomes and highlight the gaps in our current knowledge of this ecosystem.

Neonatal hepatic abscess (NHA) is a fatal condition in neonates. NHA can be caused by many organisms including bacteria, parasites, and fungi. Fungal NHA is a rare but troublesome cause in terms of diagnosis and treatment. We present three cases of fungal NHA caused by Candida. In these three cases, different underlying problems associated with NHA had been found.

Las infecciones neonatales por Candida spp. son eventos graves por su morbimortalidad, sin embargo, en países en vías de desarrollo la información epidemiológica es insuficiente. El objetivo de este estudio fue describir la incidencia y los factores asociados a la infección invasiva por Candida spp. en una unidad de cuidados intensivos neonatales de México.

Estudio de casos y controles anidado en una cohorte y apareado por el peso al nacer. Se estimó la incidencia de infección neonatal invasiva por Candida spp., y para el análisis bivariado de los factores estudiados se usó la prueba de McNemar para contraste de hipótesis y análisis multivariado con regresión logística.

La incidencia de la infección fue de 2,27 eventos/1.000 RN vivos. Las especies identificadas fueron C. albicans 35,3% (n: 30), C. parapsilosis 30,6% (n: 26), C. glabrata 31,8% (n: 27) y 2 eventos con C. lipolytica. Los factores asociados a mayor riesgo fueron la ventilación mecánica (OR: 3,04; IC 95%: 1,13-8,14), los antibióticos sistémicos (OR: 7,48; IC 95%: 1,30-42,9), el número de esquemas antimicrobianos (OR: 2,02; IC 95%: 1,01-4,03) y los días con nutrición parenteral total (OR: 1,14; IC 95%: 1,04-1,25) o con catéter venoso central (OR: 1,11; IC 95%: 1,02-1,20). La profilaxis con fluconazol disminuyó el riesgo (OR: 0,32; IC 95%: 0,12-0,84).

Las intervenciones invasivas (catéter central, ventilación mecánica y nutrición parenteral) y el uso de antimicrobianos incrementan el riesgo de infección neonatal por Candida spp., mientras que el fluconazol profiláctico es protector.

Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico.

Case-control study nested in a cohort and matched for birth weight. We estimate the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression.

The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04; 95% CI 1.13-8.14), systemic antibiotics (OR 7.48; 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02; 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14; 95% CI 1.04-1.25) or with venous catheter central (OR 1.11; 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32; 95% CI 0.12-0.84).

Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.

Most fungal infections occur in healthy children and cause self-limited, skin and mucous membrane disease. In contrast, immunocompromised and hospitalized children can suffer from invasive fungal infections that result in significant morbidity and mortality. Many of the features of invasive fungal disease are shared between adults and children. However, there are important age-related differences in disease. This is especially true for premature neonates and children with primary immunodeficiencies. In this article, we review invasive fungal infections due to Candida and Aspergillus spp., the most common causes of invasive fungal diseases in children, with a special focus on the unique characteristics of pediatric disease.

Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis.

A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey.

The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (+). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p = 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p = 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p = 0.005).

Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.