Neonatal Invasive Candidiasis in Spain: An Epidemiological Study from the “Grupo de Hospitales Castrillo”

Presenter: B. Fernandez Colomer (e-mail: [e-mail])

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