title: Candidiasis caused by Candida kefyr in a neonate: case report.
abstract: BACKGROUND
  Systemic Candidia infections are of major concern in neonates, especially in those with risk factors such as longer use of broad spectrum antibiotics. Recent studies showed that also term babies with underlying gastrointestinal or urinary tract abnormalities are much more prone to systemic Candida infection. We report a very rare case of candidiasis caused by Candida kefyr in a term neonate.
  
  
  METHODS
  Renal agenesis on the left side was diagnosed antenatally and anal atresia postnatally. Moreover, a vesico-ureteral-reflux (VUR) grade V was detected by cystography. The first surgical procedure, creating a protective colostoma, was uneventful. Afterwards our patient developed urosepsis caused by Enterococcus faecalis and was treated with piperacillin. The child improved initially, but deteriorated again. A further urine analysis revealed Candida kefyr in a significant number. As antibiotic resistance data about this non-albicans Candida species are limited, we started liposomal amphotericin B (AMB), but later changed to fluconazole after receiving the antibiogram. Candiduria persisted and abdominal imaging showed a Candida pyelonephritis. Since high grade reflux was prevalent we instilled AMB into the child's bladder as a therapeutic approach. While undergoing surgery (creating a neo-rectum) a recto-vesical fistula could be shown and subsequently was resected. The child recovered completely under systemic fluconazole therapy over 3 months.
  
  
  CONCLUSIONS
  Candidiasis is still of major concern in neonates with accompanying risk factors. As clinicians are confronted with an increasing number of non-albicans Candida species, knowledge about these pathogens and their sensitivities is of major importance.
authors.affiliation: Pediatric Infectious Diseases, University Children's Hospital Mannheim of Heidelberg University, Mannheim, Germany. Stefan.Weichert@medma.uni-heidelberg.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Weichert
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinshagen
authors.forename: Katrin
authors.initials: K
authors.lastname: Zahn
authors.forename: Gernot
authors.initials: G
authors.lastname: Geginat
authors.forename: Annebärbel
authors.initials: A
authors.lastname: Dietz
authors.forename: Anna Kristina
authors.initials: AK
authors.lastname: Kilian
authors.forename: Horst
authors.initials: H
authors.lastname: Schroten
authors.forename: Tobias
authors.initials: T
authors.lastname: Tenenbaum
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001006:Anus, Imperforate / Q000150:complications / Q000601:surgery; D002175:Candida / Q000145:classification* / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D000013:Congenital Abnormalities; D013293:Enterococcus faecalis / Q000302:isolation & purification; D015725:Fluconazole / Q000008:administration & dosage; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney / Q000002:abnormalities; D007674:Kidney Diseases / Q000150:complications / Q000151:congenital; D018805:Sepsis / Q000150:complications / Q000382:microbiology; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications / Q000382:microbiology; D014556:Urine / Q000382:microbiology; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000151:congenital
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole