Management of candida infection in the newborn
Manejo de la infección por candida en el recién nacido
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Arias F., D., & Jiménez S., J. C. (2015). Management of candida infection in the newborn. Journal of Medicine and Surgery Repertoire, 24(2), 123–130. https://doi.org/10.31260/RepertMedCir.v24.n2.2015.633
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Clinical Practice Guide
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Abstract
Worldwide, neonatal mortality corresponds to 41% of those that occur in children under five years of age. Among the causes described by WHO, sepsis corresponds to the third, after prematurity and perinatal asphyxia. Candida sp is one of the etiological agents that in the neonatal period generates high morbidity and mortality, as well as long-term neurological sequelae, especially in premature and low birth weight. These patients have their own immunological characteristics, requirements for invasive procedures and greater survival in prolonged hospital stays, which become risk factors that predispose to develop systemic candidiasis. Given the impact of this pathology, it is important to have a comprehensive diagnostic and therapeutic approach that reduces morbidity and mortality, improving vital and functional prognosis. In recent years, different medical guidelines and protocols have been generated in order to optimize the management of this infection, so it is important to describe what are the best current recommendations for the approach, diagnosis and treatment of neonatal candidiasis.
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References
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2. Hope WW, Castagnola E, Groll AH, Roilides E, Akova M, Arendrup MC, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microbiol Infect. 2012; 18 Suppl 7:38-52.
3. Kaufman DA. “Getting to Zero”: preventing invasive Candida infections and eliminating infection-related mortality and morbidity in extremely preterm infants. Early Hum Dev. 2012; 88 Suppl 2:S45-9.
4. Fridkin SK, Kaufman D, Edwards JR, Shetty S, Horan T. Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995-2004. Pediatrics. 2006; 117(5):1680-7.
5. Testoni D, Smith PB, Benjamin DK. The use of antifungal therapy in neonatal intensive care. Clin Perinatol. 2012; 39(1):83-98.
6. Pfaller M, Neofytos D, Diekema D, Azie N, Meier-Kriesche HU, Quan SP, et al. Epidemiology and outcomes of candidemia in 3648 patients: data from the Prospective Antifungal Therapy (PATH Alliance®) registry, 2004-2008. Diagn Microbiol Infect Dis. 2012; 74(4):323-31.
7. Montagna MT, Lovero G, De Giglio O, Iatta R, Caggiano G, Montagna O, et al. Invasive fungal infections in neonatal intensive care units of Southern Italy: a multicentre regional active surveillance (AURORA project). J Prev Med Hyg. 2010; 51(3):125-30.
8. Figueras C, Heredia CD, Garcia JJ, Navarro M, Ruiz-Contreras J, Rossich R, et al. [The Spanish Society of Paediatric Infectious Diseases (SEIP) recommendations on the diagnosis and management of invasive candidiasis]. An Pediatr (Barc). 2011; 74(5):337.e1-337.e17.
9. Feja KN, Wu F, Roberts K, Loughrey M, Nesin M, Larson E, et al. Risk factors for candidemia in critically ill infants: a matched case-control study. J Pediatr. 2005; 147(2):156-61.
10. Chalmers C, Gaur S, Chew J, Wright T, Kumar A, Mathur S, et al. Epidemiology and management of candidaemia--a retrospective, multicentre study in five hos- pitals in the UK. Mycoses. 2011; 54(6):e795-800.
11. Camacho-Gonzalez A, Spearman PW, Stoll BJ. Neonatal infectious diseases: evaluation of neonatal sepsis. Pediatr Clin North Am. 2013; 60(2):367-89.
12. Steinbach WJ, Roilides E, Berman D, Hoffman JA, Groll AH, Bin-Hussain I, et al. Results from a prospective, international, epidemiologic study of invasive candidiasis in children and neonates. Pediatr Infect Dis J. 2012; 31(12):1252-7.
13. Chapman RL. Prevention and treatment of Candida infections in neonates. Semin Perinatol. 2007; 31(1):39-46.
14. Sardana V, Pandey A, Madan M, Goel SP, Asthana AK. Neonatal candidemia: a changing trend. Indian J Pathol Microbiol. 2012; 55(1):132-3.
15. Benjamin DK, Stoll BJ, Gantz MG, Walsh MC, Sánchez PJ, Das A, et al. Neonatal candidiasis: epidemiology, risk factors, and clinical judgment. Pediatrics. 2010; 126(4):e865-73.
16. Oeser C, Lamagni T, Heath PT, Sharland M, Ladhani S. The epidemiology of neonatal and pediatric candidemia in England and Wales, 2000-2009. Pediatr Infect Dis J. 2013; 32(1):23-6.
17. Zaoutis TE. Invasive fungal infections in pediatric patients: challenges to optimal management. J Pediatr. 2010; 156(4):A1-S86.
18. Saiman L, Ludington E, Pfaller M, Rangel-Frausto S, Wiblin RT, Dawson J, et al. Risk factors for candidemia in Neonatal Intensive Care Unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J. 2000; 19(4):319-24.
19. Pappas PG. Invasive candidiasis. Infect Dis Clin North Am. 2006; 20(3):485-506.
20. Benjamin DK, Stoll BJ, Fanaroff AA, McDonald SA, Oh W, Higgins RD, et al. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics. 2006; 117(1):84-92.
21. Miranda LN, van der Heijden IM, Costa SF, Sousa AP, Sienra RA, Gobara S, et al. Candida colonisation as a source for candidaemia. J Hosp Infect. 2009; 72(1):9-16.
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.
26. Wilkerson J, McPherson C, Donze A. Fluconazole to prevent systemic fungal infections in infants: reviewing the evidence. Neonatal Netw. 2010; 29(5):323-33.
27. Egunsola O, Adefurin A, Fakis A, Jacqz-Aigrain E, Choonara I, Sammons H. Safety of fluconazole in paediatrics: a systematic review. Eur J Clin Pharmacol. 2013; 69(6):1211-21.
28. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110 (2 Pt 1): 285-91.
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.
36. Santolaya ME, Alvarado Matute T, de Queiroz Telles F, Colombo AL, Zurita J, Tiraboschi IN, et al. [Recommendations for the management of candidemia in neonates in Latin America. Grupo Proyecto Épico]. Rev Iberoam Micol. 2013; 30(3 Suppl 1):158-70.
37. Kaufman DA, Manzoni P. Strategies to prevent invasive candidal infection in extremely preterm infants. Clin Perinatol. 2010; 37(3):611-28.
38. El Ahmed HH, Cañadas-De la Fuente GA, Fernández-Castillo R, González-Jiménez E, Cantero-Hinojosa J, Lardón-Fernández M. [Generalized cutaneous candidiasis in newborn at term]. Biomedica. 2012; 32(2):170-3.
39. Wynn JL, Tan S, Gantz MG, Das A, Goldberg RN, Adams-Chapman I, et al. Outcomes following candiduria in extremely low birth weight infants. Clin Infect Dis. 2012; 54(3):331-9.
40. Jans J, Brüggemann RJ, Christmann V, Verweij PE, Warris A. Favorable outcome of neonatal cerebrospinal fluid shunt-associated Candida meningitis with caspofungin. Antimicrob Agents Chemother. 2013;57(5):2391-3.
41. Basu S, Kumar A, Kapoor K, Bagri NK, Chandra A. Neonatal endogenous endophthalmitis: a report of six cases. Pediatrics. 2013; 131(4):e1292-7.
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.
2. Hope WW, Castagnola E, Groll AH, Roilides E, Akova M, Arendrup MC, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microbiol Infect. 2012; 18 Suppl 7:38-52.
3. Kaufman DA. “Getting to Zero”: preventing invasive Candida infections and eliminating infection-related mortality and morbidity in extremely preterm infants. Early Hum Dev. 2012; 88 Suppl 2:S45-9.
4. Fridkin SK, Kaufman D, Edwards JR, Shetty S, Horan T. Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995-2004. Pediatrics. 2006; 117(5):1680-7.
5. Testoni D, Smith PB, Benjamin DK. The use of antifungal therapy in neonatal intensive care. Clin Perinatol. 2012; 39(1):83-98.
6. Pfaller M, Neofytos D, Diekema D, Azie N, Meier-Kriesche HU, Quan SP, et al. Epidemiology and outcomes of candidemia in 3648 patients: data from the Prospective Antifungal Therapy (PATH Alliance®) registry, 2004-2008. Diagn Microbiol Infect Dis. 2012; 74(4):323-31.
7. Montagna MT, Lovero G, De Giglio O, Iatta R, Caggiano G, Montagna O, et al. Invasive fungal infections in neonatal intensive care units of Southern Italy: a multicentre regional active surveillance (AURORA project). J Prev Med Hyg. 2010; 51(3):125-30.
8. Figueras C, Heredia CD, Garcia JJ, Navarro M, Ruiz-Contreras J, Rossich R, et al. [The Spanish Society of Paediatric Infectious Diseases (SEIP) recommendations on the diagnosis and management of invasive candidiasis]. An Pediatr (Barc). 2011; 74(5):337.e1-337.e17.
9. Feja KN, Wu F, Roberts K, Loughrey M, Nesin M, Larson E, et al. Risk factors for candidemia in critically ill infants: a matched case-control study. J Pediatr. 2005; 147(2):156-61.
10. Chalmers C, Gaur S, Chew J, Wright T, Kumar A, Mathur S, et al. Epidemiology and management of candidaemia--a retrospective, multicentre study in five hos- pitals in the UK. Mycoses. 2011; 54(6):e795-800.
11. Camacho-Gonzalez A, Spearman PW, Stoll BJ. Neonatal infectious diseases: evaluation of neonatal sepsis. Pediatr Clin North Am. 2013; 60(2):367-89.
12. Steinbach WJ, Roilides E, Berman D, Hoffman JA, Groll AH, Bin-Hussain I, et al. Results from a prospective, international, epidemiologic study of invasive candidiasis in children and neonates. Pediatr Infect Dis J. 2012; 31(12):1252-7.
13. Chapman RL. Prevention and treatment of Candida infections in neonates. Semin Perinatol. 2007; 31(1):39-46.
14. Sardana V, Pandey A, Madan M, Goel SP, Asthana AK. Neonatal candidemia: a changing trend. Indian J Pathol Microbiol. 2012; 55(1):132-3.
15. Benjamin DK, Stoll BJ, Gantz MG, Walsh MC, Sánchez PJ, Das A, et al. Neonatal candidiasis: epidemiology, risk factors, and clinical judgment. Pediatrics. 2010; 126(4):e865-73.
16. Oeser C, Lamagni T, Heath PT, Sharland M, Ladhani S. The epidemiology of neonatal and pediatric candidemia in England and Wales, 2000-2009. Pediatr Infect Dis J. 2013; 32(1):23-6.
17. Zaoutis TE. Invasive fungal infections in pediatric patients: challenges to optimal management. J Pediatr. 2010; 156(4):A1-S86.
18. Saiman L, Ludington E, Pfaller M, Rangel-Frausto S, Wiblin RT, Dawson J, et al. Risk factors for candidemia in Neonatal Intensive Care Unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J. 2000; 19(4):319-24.
19. Pappas PG. Invasive candidiasis. Infect Dis Clin North Am. 2006; 20(3):485-506.
20. Benjamin DK, Stoll BJ, Fanaroff AA, McDonald SA, Oh W, Higgins RD, et al. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics. 2006; 117(1):84-92.
21. Miranda LN, van der Heijden IM, Costa SF, Sousa AP, Sienra RA, Gobara S, et al. Candida colonisation as a source for candidaemia. J Hosp Infect. 2009; 72(1):9-16.
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.
26. Wilkerson J, McPherson C, Donze A. Fluconazole to prevent systemic fungal infections in infants: reviewing the evidence. Neonatal Netw. 2010; 29(5):323-33.
27. Egunsola O, Adefurin A, Fakis A, Jacqz-Aigrain E, Choonara I, Sammons H. Safety of fluconazole in paediatrics: a systematic review. Eur J Clin Pharmacol. 2013; 69(6):1211-21.
28. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110 (2 Pt 1): 285-91.
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.
36. Santolaya ME, Alvarado Matute T, de Queiroz Telles F, Colombo AL, Zurita J, Tiraboschi IN, et al. [Recommendations for the management of candidemia in neonates in Latin America. Grupo Proyecto Épico]. Rev Iberoam Micol. 2013; 30(3 Suppl 1):158-70.
37. Kaufman DA, Manzoni P. Strategies to prevent invasive candidal infection in extremely preterm infants. Clin Perinatol. 2010; 37(3):611-28.
38. El Ahmed HH, Cañadas-De la Fuente GA, Fernández-Castillo R, González-Jiménez E, Cantero-Hinojosa J, Lardón-Fernández M. [Generalized cutaneous candidiasis in newborn at term]. Biomedica. 2012; 32(2):170-3.
39. Wynn JL, Tan S, Gantz MG, Das A, Goldberg RN, Adams-Chapman I, et al. Outcomes following candiduria in extremely low birth weight infants. Clin Infect Dis. 2012; 54(3):331-9.
40. Jans J, Brüggemann RJ, Christmann V, Verweij PE, Warris A. Favorable outcome of neonatal cerebrospinal fluid shunt-associated Candida meningitis with caspofungin. Antimicrob Agents Chemother. 2013;57(5):2391-3.
41. Basu S, Kumar A, Kapoor K, Bagri NK, Chandra A. Neonatal endogenous endophthalmitis: a report of six cases. Pediatrics. 2013; 131(4):e1292-7.
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.