Systemic Candida Infection in Very Low Birth Weight Infants: Epidemiological Features Over 5 Years.

Lee,  Seung Woo; Lee,  Jeong Eun; Lee,  Juyoung; Lee,  Hyun Seung; Lee,  Jung Hyun; Sung,  In Kyung

Original Article

Journal of the Korean Society of Neonatology 2009;16(2):190-196.
Published online November 1, 2009.

Systemic Candida Infection in Very Low Birth Weight Infants: Epidemiological Features Over 5 Years.

Seung Woo Lee, Jeong Eun Lee, Juyoung Lee, Hyun Seung Lee, Jung Hyun Lee, In Kyung Sung

Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. frocner@catholic.ac.kr, ljhped@catholic.ac.kr

극소 저체중 출생아에서 전신성 칸디다 감염 : 5년간의 역학적 특성

^, ^, ^, ^, ^,

Abstract

PURPOSE
Candida infection has increased in neonatal intensive care units (NICU). However, recent reports on systemic candida infections in preterm newborns are rare in Korea. The aim of this study was to examine the epidemiological features of systemic candida infection in very low birth weight infants (VLBW) over the past five years.
METHODS
We retrospectively reviewed the medical records of 19 patients with systemic candida infections in VLBW that were admitted to the neonatal intensive care units of three hospitals affiliated with the College of Medicine, The Catholic University of Korea from January 2004 to December 2008. We analyzed the birth weight, gestational age, age at diagnosis, risk factors, co-morbidity, antifungal treatment, and mortality rates among the 19 patients.
RESULTS
Systemic candida infections occurred in 19 cases (4.7%) among the VLBW infants. The mean birth weight and gestational age were 959.0+/-255.9 g and 26.7+/-2.1 weeks. The isolated Candida species were C. albicans (4), C. parapsilosis (9), C. glabrata (2), C. famata (2), and unkown subspecies (2). Most patients had various associated risk factors, including a central venous catheter, broad spectrum antibiotics, parenteral nutrition, intravenous lipid emulsion, endotracheal intubation and H2 blocker therapy. There was no significant difference in the risk factors between newborns that survived and those that died with regard to the systemic candida infection, except for gestational age. Nine (47.4%) out of 19 patients with a candida infection died and four cases (21.2%) were directly related to the candida infection.
CONCLUSION
The prevalence of systemic candida infection is increasing in VLBW infants. The majority of Candida species has shifted to C. non-albicans, especially C. parapsilosis. Because of the high mortality associated with candida infection in the NICU, prophylaxis and early treatment based on epidemiological features is necessary.

Key Words: Candida; Neonatal intensive care units; Very low birth weight infant