NEONATAL CANDIDA INFECTIONS IN AN INTENSIVE CARE UNIT : A THREE YEAR EXPERIENCE

Yıl 2000, Cilt: 13 Sayı: 4, 201 - 204, 03.12.2016

Hülya Bilgen Eren Özek Nurver Ülger Nilgün Çerikcioğlu Güner Söyletir

Öz

Objective: Although technological advances in neonatal care increase survival rate in premature babies, they also contribute to the increasing incidence of systemic Candida infections in this population. Therefore, we aimed to evaluate cases with systemic Candida infections and discuss the results.
Methods: Eighteen neonates with disseminated candidiasis were evaluated according to their risk factors, culture results- and antifungal
susceptibilities.
Results: Fourteen out of eighteen were preterms and eleven of them weighed less than 1500 grams. The Candida species isolated from blood, urine or cerebrospinal fluid were Candida albicans in nine (50%), Candida parapsilosis in six (33%), Candida spp. in two (11%) cases and Candida pseudotropicalis in one (6%) case.
Antifungal susceptibility of the isolates to amphotericin B (AMB) and fluconazole (FCZ) was determined using the macrodilution method. Four of our patients received AMB while FCZ was started in fourteen cases but only ten of them showed good clinical and mycological response. In four patients the treatment was continued with AMB because of poor clinical
response although only one of them had a high minimal inhibitory concentration level to FCZ. All of our patients were treated successfully without any complication.
Conclusion: Early recognition and treatment of infants with systemic Candida infection will reduce morbidity and mortality. Identifying the Candida species and determining their susceptibility may be useful in planning the treatment of neonatal candidemia.
Key Words: Newborn, Systemic candidiasis

Kaynakça

• Hg PC. Systemic fungal infections in neonates. Arch Dis Child 1994; 71: 130-135.
• Baley JE, Kliegman KM, Fanaroff AA. Disseminated fungal infections in very low birthweight infants: clinical manifestations and epidemiology. Pediatrics 1984; 73: 144- 152.
• Jones JM. Laboratory diagnosis of invasive candidiasis. Clin Microbiol Rev 1990; 3: 32- 45.
• national Committee for Clinical Laboratory Standards: Reference method for broth dilution intifungal susceptibility testing for yeasts. Proposed Standard Document M. 27.
• P. nCCLS, Villanova, PA. 1992.
• Faix RG, Kovanik SM, Shaw TR, Johnson RV.
• Mucocutaneous and invasive candidiasis among very low birth weight (<1500 grams) infants in intensive care nurseries: a
• prospective study. Pediatrics 1998; 83: 101- 107.
• Driessen M, Ellis JB, Cooper PA, et al. Fluconazole vs. amphotericin B for the treatment of neonatal fungal septicemia: a prospective randomized trial. Pediatr Infect DisJ 1996; 15: 1 107-1 1 12.
• Driessen M, Ellis JB, Muwazi F, De Villiers FP. The treatment of systemic candidiasis in neonates with oral fluconazole. Ann Trop Paediatr 1997; 17: 263-271.
• Scarcella A, Pasquariella MB, Giugliano B, Vendemmia M, de Lucia A. Liposomal amphotericin B treatment for neonatal fungal infections. Pediatr Infect Dis J 1998; 1 7: 146- 148.
• Cruciani M, Di Perri G, Molesani M, Vento S, Concia E, Basetti D. Use of fluconazole in the treatment of Candida albicans hydrocephalus shunt infection. EurJ Clin Microbiol Infect Dis (Letter) 1992; 11: 957.
• Lackner LI, Schwinger W, Urban C, et al. Liposomal amphotericin-B (AmBisome) for treatment of disseminated fungal infections in two infants of very low birth weight. Pediatrics