Manejo de la infección por candida en el recién nacido

Management of candida infection in the newborn

A nivel mundial la mortalidad neonatal corresponde al 41% de las que ocurren en menores de cinco años. Dentro de las causas descritas por la OMS la sepsis corresponde a la tercera, después de la prematurez y la asfixia perinatal. La Candida sp es uno de los agentes etiológicos que en el período neonatal genera alta morbilidad y mortalidad, así como secuelas neurológicas a largo plazo en especial en prematuros y de bajo peso. Estos pacientes cuentan con características inmunológicas propias, requerimientos de procedimientos invasivos y mayor sobrevida en estancias hospitalarias prolongadas, que se convierten en factores de riesgo que predisponen a desarrollar candidiasis sistémica. Dado el impacto de esta patología es importante contar con un abordaje integral diagnóstico y terapéutico eficaz que disminuya la morbimortalidad, mejorando el pronóstico vital y funcional. En los últimos años se han generado diferentes guías y protocolos médicos en busca de optimizar el manejo de esta infección, por lo que es importante describir cuales son las mejores recomendaciones actuales para el enfoque, diagnóstico y tratamiento de la candidiasis neonatal.

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22. Bliss JM, Wong AY, Bhak G, Laforce-Nesbitt SS, Taylor S, Tan S, et al. Candida virulence properties and adverse clinical outcomes in neonatal candidiasis. J Pediatr. 2012; 161(3):441-7.e2.

23. Clerihew L, McGuire W. Antifungal therapy for newborn infants with invasive fungal infection. Cochrane Database Syst Rev. 2012; 6:CD003953.

24. Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009; 48(5):503-35.

25. Turner K, Manzoni P, Benjamin DK, Cohen-Wolkowiez M, Smith PB, Laughon MM. Fluconazole pharmacokinetics and safety in premature infants. Curr Med Chem. 2012; 19(27):4617-20.

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29. Smith PB, Steinbach WJ, Cotten CM, Schell WA, Perfect JR, Walsh TJ, et al. Caspofungin for the treatment of azole resistant candidemia in a premature infant. J Perinatol. 2007; 27(2):127-9.

30. Roilides E. Invasive candidiasis in neonates and children. Early Hum Dev. 2011; 87 Suppl 1:S75-6.

31. 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(1):F65-9.

32. Hsieh E, Smith PB, Jacqz-Aigrain E, Kaguelidou F, Cohen-Wolkowiez M, Manzoni P, et al. Neonatal fungal infections: when to treat?. Early Hum Dev. 2012; 88 Suppl 2:S6-S10.

33. Le J, Tran TT, Bui I, Wang MK, Vo A, Adler-Shohet FC. Time to initiation of antifungal therapy for neonatal candidiasis. Antimicrob Agents Chemother. 2013; 57(6):2550-5.

34. Greenberg RG, Benjamin DK, Gantz MG, Cotten CM, Stoll BJ, Walsh MC, et al. Empiric antifungal therapy and outcomes in extremely low birth weight infants with invasive candidiasis. J Pediatr. 2012; 161(2):264-9.

35. Mohamed WA, Ismail M. A randomized, double-blind, prospective study of caspofungin vs. amphotericin B for the treatment of invasive candidiasis in newborn infants. J Trop Pediatr. 2012; 58(1):25-30.

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37. Kaufman DA, Manzoni P. Strategies to prevent invasive candidal infection in extremely preterm infants. Clin Perinatol. 2010; 37(3):611-28.

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42. Hacimustafaoglu M, Celebi S. Candida infections in non-neutropenic children after the neonatal period. Expert Rev Anti Infect Ther. 2011; 9(10):923-40.

43. Healy CM. Fungal prophylaxis in the neonatal intensive care unit. Neoreviews. 2008;9(12):e562-e70.

44. Healy CM, Campbell JR, Zaccaria E, Baker CJ. Fluconazole prophylaxis in extremely low birth weight neonates reduces invasive candidiasis mortality rates without emergence of fluconazole-resistant Candida species. Pediatrics. 2008; 121(4):703-10.

45. O’Grady MJ, Dempsey EM. Antifungal prophylaxis for the prevention of neonatal candidiasis?. Acta Paediatr. 2008; 97(4):430-3.

46. Manzoni P, Stolfi I, Pugni L, Decembrino L, Magnani C, Vetrano G, et al. A multicenter, randomized trial of prophylactic fluconazole in preterm neonates. N Engl J Med. 2007; 356(24):2483-95.

47. Cornely OA, Marty FM, Stucker F, Pappas PG, Ullmann AJ. Efficacy and safety of micafungin for treatment of serious Candida infections in patients with or without malignant disease. Mycoses. 2011; 54(6):e838-47.

48. Kung YH, Hsieh YF, Weng YH, Lien RI, Luo J, Wang Y, et al. Risk factors of late-onset neonatal sepsis in Taiwan: A matched case-control study. J Microbiol Immunol Infect. 2013: S1684-1182(13)00195-3.

49. Knowles SJ. Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit. J Hosp Infect. 2009; 71(1):95-6.

50. Romeo MG, Romeo DM, Trovato L, Oliveri S, Palermo F, Cota F, et al. Role of probiotics in the prevention of the enteric colonization by Candida in preterm newborns: incidence of late-onset sepsis and neurological outcome. J Perinatol. 2011; 31(1):63-9.