Risk Factors for Progression to Invasive Fungal Infection in Preterm Neonates With Fungal Colonization
| Autor: | Elisa Antonielli d'Oulx, Giovanna Gomirato, Roberto Miniero, Paolo Manzoni, Paolo Galletto, Michael Mostert, Daniele Farina, MariaLisa Leonessa |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Birth weight medicine.medical_treatment very low birth weight Infant Premature Diseases preterm infant Sepsis Risk Factors Humans Medicine Neonatology Risk factor Mycosis Candida business.industry Infant Newborn colonization medicine.disease infection progression Low birth weight Mycoses Case-Control Studies Pediatrics Perinatology and Child Health Disease Progression Female medicine.symptom business Fluconazole Central venous catheter medicine.drug |
| Zdroj: | Pediatrics. 118:2359-2364 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.2006-1311 |
| Popis: | OBJECTIVE. Colonization by Candida spp is a major risk factor for development of fungal sepsis, but little is known about the variables associated with progression to invasive disease in already colonized neonates. We investigated such variables in a large number of colonized preterm neonates in an NICU.SETTING. This study was conducted in the Department of Neonatology and the NICU at Sant'Anna Hospital in Torino, Italy.DESIGN AND PATIENTS A database search of clinical charts and weekly surveillance cultures was used to identify all neonates with birth weights RESULTS. Colonization occurred in 201 infants (32.1% of very low birth weight admitted neonates), and invasive fungal infection occurred in 51 (8.1%) of them, with an overall progression rate of 0.25. At univariate analysis, 10 factors (namely low birth weight, low gestational age, use of third-generation cephalosporins, endotracheal intubation, duration of stay in the NICU, bacterial sepsis, colonization of central venous catheter, of endotracheal tube, of gastric aspirate, or in ≥3 [multiple] sites) were associated with an increased risk of progression, whereas prophylaxis with fluconazole was associated to a decreased risk. After logistic regression, only colonization of central venous catheter and colonization in multiple sites remained significantly associated with invasive fungal infection. Fluconazole prophylaxis remained an independent protective factor.CONCLUSIONS. Central venous catheter colonization and multiple-site colonization are independent risk factors and predictors of progression to fungal sepsis in preterm very low birth weight neonates colonized by Candida spp during their stay in the NICU. Fluconazole prophylaxis is an independent protective factor. These findings can be used to improve the surveillance, prophylaxis, or preemptive measures in neonates at high risk. |
| Databáze: | OpenAIRE |
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