ASSOCIATION OF FUNGAL COLONIZATION AND INVASIVE DISEASE IN VERY-LOW-BIRTH-WEIGHT INFANTS

Background. Fungi are common pathogens of nosocomial infections in the very low birth weight (VLBW) infants. The purpose of this study was t o investigate the fungal colonization rate in VLBW infants and the ass ociation between fungal colonization and systemic fungal diseases. Mat erials. Between January 1, 1996, and December 31, 1996, 116 infants wi th birth weight <1500 g admitted to the neonatal intensive care unit o f Chang Gung Children's Hospital in the first day of life were include d in this prospective study. Methods. Cultures from oropharynx, rectum , skin (groin and axilla), bag urine and endotracheal aspirates were o btained in the first 24 h after birth and weekly thereafter throughout their neonatal intensive care unit stay. Medical records were reviewe d weekly. Results. Fungal colonization was detected in 25 infants, amo ng whom 17 infants developed colonization by 2 weeks of life. Candida albicans (61%) and Candida parapsilosis (29%) were the 2 most common o rganisms. The rectum (76%) was the most frequent site of colonization. Factors significantly associated with colonization were prolonged adm inistration of antibiotic therapy, parenteral nutrition and intralipid emulsion. Three of 116 infants developed fungemia, The association be tween colonization and subsequent fungemia was demonstrated in 1 infan t, representing 4% of colonized infants. Conclusion. Fungal colonizati on was detected in one-fifth of VLBW infants and represents a risk fac tor for fungemia, Because disease occurred in the absence of apparent colonization, factors other than colonization may contribute to invasi ve candidiasis.