The burden of Candida species colonization in NICU patients: a colonization surveillance study

摘要

Fungal infections are an important causeof morbidity and mortality in neonatalintensive care units (NICUs). The identificationof specific risk factors supports preventionof candidemia in neonates. Effectiveprophylactic strategies have recentlybecome available, but the identificationand adequate management of high-risk infantsis still a priority. Prior colonization isa key risk factor for candidemia. For thisreason, surveillance studies to monitor incidence,species distribution, and antifungalsusceptibility profiles, are mandatory.Among 520 infants admitted to our NICUbetween January 2013 and December2014, 472 (90.77%) were included in thestudy. Forty-eight out of 472 (10.17%) patientstested positive for Candida spp. (C.),at least on one occasion. All the colonizedpatients tested positive for the rectal swab,whereas 7 patients also tested positive forthe nasal swab. Fifteen out of 472 patients(3.18%) had more than one positive rectalor nasal swab during their NICU stay.Moreover, 9 out of 15 patients tested negativeat the first sampling, suggesting theyacquired Candida spp. during their stay.Twenty-five of forty-eight (52.1%) colonizedpatients carried C.albicans and 15/48(31.25%) C.parapsilosis. We identified asrisk factors for Candida spp. colonization:antibiotic therapy, parenteral nutrition,the use of a central venous catheter, andnasogastric tube. Our experience suggeststhat effective microbiological surveillancecan allow for implementing proper, effectiveand timely control measures in a highrisksetting.