Further to the review by Brecht et al[1], we report our recent experience of Candida blood stream infections (CBSI’s) in our tertiary service. Over an 8 year period, we identified 30 infants with CBSI’s from a cohort of 1474 VLBW infants (2%). The incidence was 6% and 4.3%, for infants born weighing <750 and 750-1000 grams respectively.

This is similar to the incidence reported in 2002 by the National Institute of Child Health and Human Development Neonatal Network[2]. More recently, the National Nosocomial Infections Surveillance System (1995- 2004), have identified a falling incidence in infants weighing <1000g and a very wide range in incidence between hospitals[3]. However, from 2004 we have seen an increase in CBSI’s (Table 1).

Also in our experience, the median day of life for a positive blood culture was only 10 days (range 4-83 days). This is earlier than expected3 and may represent an increase in perinatally acquired infection. More than half of mothers had received antibiotics in the month before delivery. Candida albicans species was identified in 21 cases and Candida parasilosis in 4 cases. Seven cases (23%) cases had a either NEC or isolated bowel perforation. All had central lines. In fourteen patients, Candida was also found in urine (Table 2).

Since 2006, Caspofungin has been used as a second line agent in four cases and was used as first line treatment in seven cases, with a trend towards improved survival. We don’t routinely use intravenous antifungals with episodes of presumed sepsis. But we now have a low threshold for considering CBSI as a cause of sepsis, early in the neonatal period in extremely premature babies, particularly in the presence of early broken skin, central lines and abdominal problems.

REFERENCES

1. Brecht M, Clerihew L, McGuire W. Prevention and treatment of invasive fungal infection in very low birthweight infants. Arch. Dis. Child. Fetal Neonatal Ed 2009;94:F65-69.

2. Stoll B, Hansen N, Fanaroff A, et al. Late-onset sepsis in very low birth weight neonatas: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285-91.

3. Fridkin SK, Kaufman D, Edwards JR, et al. Changing incidence of Candida bloodstream infections among NICU patients in the United States:1995-2004. Pediatrics 2006;117:1680-7.