Review of 49 neonates with acquired fungal sepsis: Further characterization

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 neonata l intensive care unit (NICU) admissions in the past 10 years and detected 4 9 neonates with AFS. We then compared their data with those of 49 matched c ontrol neonates who did not have AFS. The following details were collected: gestational, perinatal and neonatal courses; bacterial sepsis; antibacteri al therapy; laboratory and imaging investigations; and antifungal therapy a nd 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 thr ough 1992, between 1993 and 1995 the rate of AFS in VLBW neonates significa ntly increased (3.8%-5.6% --> 9.6%-12.9%), along with a significant increas e of NICU admission rate (369-410 --> 496-510 admissions/year). Compared wi th controls, AFS neonates had significantly longer hospitalizations, higher rates of mechanical ventilation, umbilical vein catheterization, and previ ous treatment with broad-spectrum antibacterial agents (amikacin, vancomyci n, ceftazidime, or imipenem). At the onset of AFS, 42.8% of patients had hy perthermia and 40.9% had normal white blood cell count. Causative fungi wer e 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 neona tal AFS. Second, mechanical ventilation and antibacterial agents are signif icant risk factors for AFS. Third, hyperthermia is a frequent presenting si gn of AFS. Fourth, a normal white blood cell count does not rule out AFS. F ifth, meningeal involvement in neonatal AFS should be ruled out before init iation of antifungal therapy. Sixth, the policy of empiric antifungal thera py for AFS should be considered on an individual NICU basis.