429. Epidemiology of Invasive Fungal Infections in Two Tertiary Care Neonatal Intensive Care Units Over an 11-year Period (2000-2011)
Session: Poster Abstract Session: Pediatric Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_40705.pdf (861.8 kB)
  • Background:  Invasive fungal infections (IFI) are important nosocomial infections in the neonatal intensive care unit (NICU).  Data on IFI in the neonatal population is limited. We therefore studied the epidemiology of IFI including trends and outcome of Candida bloodstream infection (BSI) in our NICUs.

    Methods: Retrospective chart review of patients with IFI from January 2000-December 2011 in our 2 NICUs was done. Clinical and microbiological data of Candida BSI and factors associated with end organ dissemination and clearance were further studied.

    Results:  We identified 168 patients with IFI. Pathogens included: Candida sp. (BSI n=152 (158 episodes), urinary tract infection n=7, meningitis n=1), Malassezia sp. n=5, Aspergillus sp. n=2 and Rhodotorula sp. n=1. Patients with Candida BSI were further analyzed: mean age at diagnosis was 49 (4-390) days; mean estimated gestational age (EGA) was 28±4 weeks and 92/158 (58%) were extremely low birth weight infants (ELBW, birth weight (BW) ≤1000gm). Overall C. albicans 75/158 (47%) was the most common species; however, there was an increase in non-albicans sp. from years 2006-2011. End organ dissemination (kidneys n=30, brain n=12, heart n=8 and eyes n=7) was more frequent in patients with EGA ≤32 weeks 45/104 (43%) vs. EGA >32 weeks 2/15 (13%), p=0.04. Lipid formulation of amphotericin B was the most common antifungal used.  Combination antifungal use increased during years 2006-2011 [41/56 (73%)] vs. years 2000-2005 [50/102 (49%)] and in patients with end organ dissemination 40/48 (83%) vs. those without 42/77 (54%), p<0.05. Candida BSI clearance rates (negative blood culture after antifungal initiation) were lower in ELBW infants 77/99 (77%) vs. BW >1000gm 55/59 (93%), p=0.01 as well as in infections with C. albicans 63/82 (77%) vs. non-albicans sp. 69/76 (91%), p=0.01. Clearance rates improved from years 2000-2005 (70%-90%) to years 2006-2011 (86-100%).

    Conclusion:  Candida BSI was the most common IFI seen in our NICUs. Factors associated with non-clearance of Candida BSI included ELBW infants and C. albicans infection.  End organ dissemination occurred more frequently in infants with EGA ≤32 weeks. Successful clearance of Candida BSI has improved over the last 11 years. This may be due to increase in non-albicans species and the use of combination antifungals. Continued surveillance is needed.

    Roshani Agarwal, MD1, Rajkumar Agarwal, MD1, Jorge Lua, MD2,3, Xinguang Chen, MD, PhD4 and Jocelyn Ang, MD3,5, (1)Pediatrics, Childrens Hospital of Michigan, Detroit, MI, (2)Pediatrics, Division of Neonatal and Perinatal Medicine, Children's Hospital of Michigan, Detroit, MI, (3)Pediatrics, Wayne State University School of Medicine, Detroit, MI, (4)Pediatrics, Wayne State University School Of Medicine, Detroit, MI, (5)Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan, Detroit, MI

    Disclosures:

    R. Agarwal, ASTELLAS SCIENTIFIC AND MEDICAL AFFAIRS, INC. : Investigator, Research support

    R. Agarwal, ASTELLAS SCIENTIFIC AND MEDICAL AFFAIRS, INC. : Investigator, Research support

    J. Lua, ASTELLAS SCIENTIFIC AND MEDICAL AFFAIRS, INC. : Grant Investigator, Grant recipient

    X. Chen, ASTELLAS SCIENTIFIC AND MEDICAL AFFAIRS, INC. : Investigator, Research grant

    J. Ang, ASTELLAS SCIENTIFIC AND MEDICAL AFFAIRS, INC. : Grant Investigator, Grant recipient

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