URINARY-TRACT CANDIDIASIS IN NEONATES AND INFANTS

Objective To examine the range of disease caused by invasive Candida i nfection in neonates and infants and to discuss the available treatmen t options, particularly surgery and drug therapy. Patients and methods Five consecutive infants with invasive urinary tract Candida infectio n presenting over an 18-month period were reviewed, Treatment protocol s included a combination of surgery and treatment with amphotericin, f lucytosine and fluconazole. Results The range of disease severity from simple Candida urinary tract infection to overwhelming multi-organ se psis was demonstrated. Urinary tract obstruction was identified as a p redisposing factor in three of the five cases. In all cases, infection was cleared by the treatment protocol, Two cases with bilateral renal pelvic fungal balls showed resolution with no surgery in three kidney s and showed no advantage of pyelotomy and perfusion. Conclusion The r esults question the role of surgery, which may be limited to the relie f of primary urological obstruction. We advocate the use of oral fluco nazole to prevent or treat early systemic infection and, for severe sy stemic infections, a prolonged course of fluconazole in combination wi th flucytosine should be considered as an alternative to amphotericin, which is toxic and can only be given intravenously.