Background changing patterns of neonatal fungal sepsis in a developing country

• Published in: Journal of tropical pediatrics (1980) Vol. 59; no. 6; p. 460
• Main Authors: Ballot, Daynia E, Bosman, Noma, Nana, Trusha, Ramdin, Tanisha, Cooper, Peter A
• Format: Journal Article
• Language: English
• Published: England 01.12.2013
• Subjects: Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Birth Weight; Candida - classification; Candida - drug effects; Candida - isolation & purification; Candidemia - diagnosis; Candidemia - drug therapy; Candidemia - epidemiology; Candidemia - microbiology; Candidiasis - diagnosis; Candidiasis - drug therapy; Candidiasis - microbiology; Candidiasis - mortality; Drug Resistance, Fungal; Female; Fluconazole - pharmacology; Fluconazole - therapeutic use; Humans; Incidence; Infant, Newborn; Male; Microbial Sensitivity Tests; Pyrimidines - pharmacology; Pyrimidines - therapeutic use; Risk Factors; Socioeconomic Factors; South Africa - epidemiology; Treatment Outcome; Triazoles - pharmacology; Triazoles - therapeutic use; Voriconazole; South Africa; fungal sepsis; fungal bloodstream infections; neonates; Candida
• DOI: 10.1093/tropej/fmt053

Candida albicans is the predominant isolate in many neonatal fungal bloodstream infections (BSIs), so fluconazole is used as empiric antifungal therapy. To determine the predominant organisms, antifungal sensitivity patterns, clinical and demographic risk factors and crude mortality rate in neonatal fungal BSI cases. This is a review of all neonatal fungal BSI cases between January 2007 and December 2011. Fifty-nine patients were included in the study. Candida parapsilosis (54.2%) was isolated in majority of the cases, followed by C. albicans (27.1%). Fluconazole resistance was present in 16 of 32 cases of C. parapsilosis versus 1 of 16 cases of C. albicans (P = 0.003). Mortality rate was 45.8%. Surgical problems were present in 55.9%. Death was significantly associated with lower birth weight (P = 0.046) and necrotizing enterocolitis (P = 0.034). The increase in neonatal fungal BSI and resistant organisms highlights the need to review use of routine empiric fluconazole and to implement preventive measures.