1 - Maternidade Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central, Lisbon, Portugal;
2 - Hospital Fernando da Fonseca, Lisbon, Portugal;
3 - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal;
4 - Hospital de Dona Estefânia, Centro Hospitalar Lisboa Central, Lisbon, Portugal
- 3th UENPS Meeting 2012. 14-17 /11. Porto (Comunicação oral).
Introduction: The burden of invasive fungal infection (IFI) in Neonatal Intensive Care Units (NICUs) has increased significantly during the past years. Despite prompt and appropriate treatment, disseminated disease, long-term sequelae, prolongation of hospitalization and death still result from IFI. The aim of this study was to assess the epidemiology of fungal infection in Portuguese NICUs and to compare efficacy and safety of antifungal therapies.
Methods: An observational, multicenter retrospective study was carried out in the metropolitan area of Lisbon, Portugal. Four NICUs were enrolled. The period in analysis was January 2005- December 2010.
An analysis of 75 variables was done including potential risk factors for IFI, causative pathogens, treatment characteristics and outcome. Specific side effects as well as serious adverse reactions related to the antifungal therapy were evaluated.
Results: During the study period, 44 infants were enrolled. The median gestational age was 26 weeks (Q1-Q3:25-31 weeks) and the median birth weight 751g (Q1-Q3:630-1290g). Twenty nine neonates had extreme low birth weigh (65.9%). The global incidence of IFI in ELBW patients was 4.1%. Surgical necrotizing enterocolitis was present in 9 (20.5%) patients. The presence of a central venous catheter was the most frequent potential risk factor to IFI (100%). Moreover, antibiotics, total parenteral nutrition and the use of endotracheal tube were also very common (95.5%, 95.5% and 61.4% respectively). The bloodstream infection was the most frequent IFI (75%) with Candida albicans and Candida parapsilosis being the most frequent pathogens. Overall, 28 patients (63.8%) were treated with Ambisome® (L-AmB).
Clinical side effects were not reported in any patient but some laboratorial side effects were found (serum alanine aminotransferase>50U/L, serum creatinine level>1.5mg/dl, serum magnesium < 1.5 mg/dl). Case fatality rate in all patients was 11.4%.
Conclusions: The results of this study outline the impact of IFI, especially in the extremely premature infants and in those with gastrointestinal disease. Our study results have been positive in demonstrating efficacy of antifungals: the majority of patients submitted to these therapies survived. Neonatal IFI continues to represent a challenge to the clinician. The knowledge of the local epidemiology helps to clarify the best prophylactic and treatment strategies.
Key-words: Neonatal intensive care unit, fungal infection, prophylaxis.