Presenter: B. Fernandez Colomer (e-mail: bcolomer@gmail.com)
Introduction: Invasive fungal infections, especially Candidemia, are a serious problem in very
low-birth-weight babies (VLBWB) and a leading cause of neonatal morbidity and mortality.
Their frequency is related to the immaturity host defenses, frequent exposure to invasive
diagnostic and treatment procedures and prolonged hospital stay of these babies. The
objective of this report is to describe the epidemiology of neonatal invasive candidiasis
in Spain over the past 10 years.
Materials and Methods: Since 2006, the neonatal services of 40 third level NICUs from Academic teaching
hospitals in Spain (“Grupo de Hospitales Castrillo”) carry out a prospective surveillance
of the epidemiology of nosocomial sepsis in VLBWB. Here we present the results related
to all cases of neonatal Candidemia occurred in the period 2006 to 2014. Of note,
routine fluconazole prophylaxis, in selected patients, was started from 2008 to 2013
in 50% of participating hospitals.
Results: There were 5,082 episodes of nosocomial sepsis among 17,274 admissions (29.4%) in
the study period, and 365 of these episodes were candidemias (2.1%). Between 2006
and 2014, the incidence of candidemia decreased significantly from 3.3 to 1.0% (p < 0.01), especially in infants lower than 1,000 g (from 5.5 to 1.3%). Related to
the etiology of nosocomial sepsis, Candida spp. were the third more frequently isolated pathogen (7.1%) after Staphylococcus epidermidis (48.3%) and Klebsiella spp. (10.8%). C. albicans was the most common cause of Candidemia (42.2%) followed by C. parapsilosis (36.9%), C. glabrata (4.7%), and C. tropicalis (3.9%). In 97.2% of infants with candidemia, four or more specific risk factors were
reported. The most common antifungal agent used was liposomal amphotericin B (80.5%)
followed by fluconazole (21.2%). The median treatment length was 21 days (IQR: 15–24).
The overall mortality rate was 19.4% and was higher in those cases caused by C. tropicalis (35.7%) and C. albicans (22.4%) compared with C. parapsilosis (15%). No isolated Candida species showed resistance to amphotericin B nor Micafungin, and only 4.5% to 5-fluocytosine
and 4.3% to fluconazole.
Conclusion:
Candida spp. is a frequently isolated pathogen in nosocomial neonatal sepsis and with a high
associated mortality rate. In our country, the incidence has declined significantly
in recent years, with C. albicans being the most frequently isolated species. All isolated Candida species were sensitive to Amphotericin B and Micafungin. Resistance to fluconazole
remained stable and negligible.
Keywords: nosocomial neonatal sepsis, late-onset neonatal sepsis, candidemia, VLBW
