Early mannan detection in bronchoalveolar lavage fluid with preemptive treatment reduces the incidence of invasive Candida infections in preterm infants.
BACKGROUND
Candida colonization is an important predictor for development of invasive fungal infection (IFI). We investigated whether early detection of Candida mannan (Mn) in bronchoalveolar lavage fluid (BALF) reduces IFI among preterm infants.


METHODS
We conducted an observational study of infants with gestational age of < or =28 weeks, where a group undergoing Candida surveillance cultures (pre-Mn detection group) was compared with a group defined after the initiation of routine use of Candida Mn detection in BALF (Mn detection group). Antifungal treatment was started based on positive microbiologic (surveillance culture or Mn-antigen assay) results.


RESULTS
No significant differences were detected when the groups were compared for several predictors of IFI. IFI was observed for 12 (23%) of 51 infants in the pre-Mn detection group, and for 0 (0%) of 29 infants in the Mn detection group (P = 0.003). Surveillance cultures in the pre-Mn detection group became positive at 15.0 +/- 7.2 days after birth, whereas the mean age at time of positive Mn antigen results in the Mn detection group was 4.3 +/- 3.1 days (P < 0.0001). Among 16 infants positive for surveillance cultures, 12 (75%) developed IFI (P < 0.0001).


CONCLUSIONS
This study suggests that Candida Mn detection in BALF may be useful for earlier identification and preemptive therapy targeting preterm infants at high risk of IFI.
Posteraro
Brunella
B
Institutes of Microbiology, Division of Neonatology, Università Cattolica del Sacro Cuore, Rome, Italy.
Sanguinetti
Maurizio
M
Boccia
Stefania
S
De Feo
Emma
E
La Sorda
Marilena
M
Tana
Milena
M
Tirone
Chiara
C
Aurilia
Claudia
C
Vendettuoli
Valentina
V
Fadda
Giovanni
G
Romagnoli
Costantino
C
Vento
Giovanni
G
D000935:Antifungal Agents / Q000627:therapeutic use*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008351:Mannans / Q000032:analysis*; D047928:Premature Birth
D000935:Antifungal Agents; D008351:Mannans