title: Review of 49 neonates with acquired fungal sepsis: further characterization.
abstract: BACKGROUND
  Neonatal acquired fungal sepsis (AFS) is a risky condition that warrants every effort for early diagnosis and management.
  
  
  METHODS
  We retrospectively reviewed the medical charts of all 4445 neonatal intensive care unit (NICU) admissions in the past 10 years and detected 49 neonates with AFS. We then compared their data with those of 49 matched control neonates who did not have AFS. The following details were collected: gestational, perinatal and neonatal courses; bacterial sepsis; antibacterial therapy; laboratory and imaging investigations; and antifungal therapy and its complications.
  
  
  RESULTS
  The incidence of AFS was.4 to 2 cases per 1000 live-births and 3.8% to 12.9% of very low birth weight (VLBW) infants. Compared with 1989 through 1992, between 1993 and 1995 the rate of AFS in VLBW neonates significantly increased (3. 8%-5.6% --> 9.6%-12.9%), along with a significant increase of NICU admission rate (369-410 --> 496-510 admissions/year). Compared with controls, AFS neonates had significantly longer hospitalizations, higher rates of mechanical ventilation, umbilical vein catheterization, and previous treatment with broad-spectrum antibacterial agents (amikacin, vancomycin, ceftazidime, or imipenem). At the onset of AFS, 42.8% of patients had hyperthermia and 40.9% had normal white blood cell count. Causative fungi were as follows: Candida albicans-42.8% of cases, Candida parapsilosis-26.5%, and Candida tropicalis-20.4%. Fungal dissemination was rare, complications of antifungal therapy were infrequent, and no deaths occurred.
  
  
  CONCLUSIONS
  First, non-albicans Candida have become more frequent in neonatal AFS. Second, mechanical ventilation and antibacterial agents are significant risk factors for AFS. Third, hyperthermia is a frequent presenting sign of AFS. Fourth, a normal white blood cell count does not rule out AFS. Fifth, meningeal involvement in neonatal AFS should be ruled out before initiation of antifungal therapy. Sixth, the policy of empiric antifungal therapy for AFS should be considered on an individual NICU basis.newborn infant, fungal sepsis, clinical signs, risk factors.
authors.affiliation: Department of Neonatology, Rambam Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. makhoul@rambam.health.gov.il
authors.forename: I R
authors.initials: IR
authors.lastname: Makhoul
authors.forename: I
authors.initials: I
authors.lastname: Kassis
authors.forename: T
authors.initials: T
authors.lastname: Smolkin
authors.forename: A
authors.initials: A
authors.lastname: Tamir
authors.forename: P
authors.initials: P
authors.lastname: Sujov
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D017668:Age of Onset; D003428:Cross Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D004452:Echocardiography; D004453:Echoencephalography; D005334:Fever / Q000209:etiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007557:Israel; D007668:Kidney / Q000000981:diagnostic imaging; D007902:Length of Stay; D009181:Mycoses / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D012044:Regression Analysis; D012160:Retina / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors