title: Invasive fungal infections in neonatal intensive care units of Southern Italy: a multicentre regional active surveillance (AURORA project).
abstract: BACKGROUND
  During the past years invasive fungal infections (IFIs) have become an increasingly important problem in infants hospitalized in the Neonatal Intensive Care Unit (NICU). Candida species is the third most-common agent of late-onset infections in critically ill neonates, with an estimated incidence of 2.6-10% in very low birth weight and 5.5-20% in extremely low birth weight infants. The aim of this observational study is to evaluate the epidemiology of IFIs among infants admitted to NICUs of one Italian region by a multicenter surveillance (Aurora Project).
  
  
  METHODS
  The IFIs surveillance was carried out prospectively in Apulia (Southern Italy) between February 2007 and August 2008. This report focuses on the results from 6 enrolled NICUs.
  
  
  RESULTS
  Twenty-one neonates developed IFIs: the overall incidence was 1.3% and crude mortality was 23.8%. Infants weighing < or = 1500 g (4.3%) showed a significantly higher incidence than those > or = 2500 g (0.2%). C. parapsilosis (61.9%) was the most frequent isolated species. The main potential risk factors were having a central venous catheter placed, length of stay in NICU > 7 days and total parenteral nutrition for > 5 days. The (1,3)-beta-D glucan (BDG), mannan antigens and anti-Candida antibodies' evaluation was performed in 7 neonates. All neonates were positive to the BDG; the mannan antigen result was positive in 5 newborns, the anti-mannan antibodies were always negative. All isolates were amphotericin B and fluconazole-susceptible.
  
  
  CONCLUSIONS
  This first prospective study on neonatal fungal infection in one Italian region gives evidence of a preponderance of non-albicans Candida spp and indicates potential utility of BDG as an adjunct diagnostic test.
authors.affiliation: Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari Aldo Moro, Italy. montagna@igiene.uniba.it
authors.forename: M T
authors.initials: MT
authors.lastname: Montagna
authors.forename: G
authors.initials: G
authors.lastname: Lovero
authors.forename: O
authors.initials: O
authors.lastname: De Giglio
authors.forename: R
authors.initials: R
authors.lastname: Iatta
authors.forename: G
authors.initials: G
authors.lastname: Caggiano
authors.forename: O
authors.initials: O
authors.lastname: Montagna
authors.forename: N
authors.initials: N
authors.lastname: Laforgia
mesh_terms: D002175:Candida / Q000276:immunology / Q000302:isolation & purification; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D011159:Population Surveillance / Q000379:methods; D015397:Program Evaluation; D011446:Prospective Studies