Invasive fungal infections in very low birthweight infants
Given the high mortality and the difficulty in establishing an early diagnosis, there was a need to assess the effect of strategies to prevent invasive fungal infection in very low-birth-weight infants(VLBW). The evaluation of such measures would be assisted by the availability of national epidemiological data in an unselected population of VLBW infants. The study aims to determine the incidence of invasive fungal infection in VLBW infants and describe the patterns and clinical spectrum of presentation. Additionally, to determine which fungi were responsible, elicit treatment strategies and describe clinical outcomes at 37 weeks post-gestational age.
Lead investigator
Dr W McGuire
About the study
Around 2003, nosocomial invasive fungal infection, most commonly due to Candida spp., was an increasingly common cause of morbidity and mortality in preterm infants cared for in the neonatal intensive care setting. There was an increase in the incidence over the 20 years before the study. This could have been due to improved survival rates of very immature infants and the invasive and intensive care they need.
The estimated incidence of invasive fungal infection in very low-birth-weight infants (VLBW: birth weight <1500 g) was approximately 2%. The incidence in extremely low-birth-weight infants (ELBW: birth weight <1000 g) was estimated to be as high as 10%. However, these estimates were based on limited case series from tertiary centres in North America, which may have been affected by referral and ascertainment biases.
In neonatal intensive care units, systemic candidal infection accounted for about 10% of all cases of sepsis diagnosed in infants more than 72 hours old. The estimated attributable mortality of about 25% was much higher than that associated with invasive bacterial infection.
The clinical presentation of invasive fungal and bacterial infection was similar. In addition to fungaemia, infants may have presented with pneumonia, meningitis, renal tract infection, ophthalmitis, osteomyelitis, endocarditis, and skin abscesses. The diagnosis may have been delayed due to an inability to recover the organism consistently from blood, cerebrospinal fluid (CSF), or urine.
Given the high mortality and the difficulty in establishing an early diagnosis, there was a need to assess the effect of strategies to prevent invasive fungal infection in VLBW infants. The evaluation of such measures would be assisted by the availability of national epidemiological data in an unselected population of VLBW infants.
The aim of the study is to:
- Determine the incidence of invasive fungal infection in very low-birth-weight infants.
- Describe the patterns and clinical spectrum of presentation.
- Determine which fungi are responsible (including anti-fungal resistance patterns).
- Elicit treatment strategies.
- Describe clinical outcomes at 37 weeks post-gestational age.
Duration
February 2003 – February 2004
Published papers
Clerihew L, Lamagni TL, Brocklehurst P, McGuire W. Invasive fungal infection in very low birthweight infants: national prospective surveillance study. Arch Dis Child Fetal Neonatal Ed. 2006 May;91(3):F188-92. doi: 10.1136/adc.2005.082024. Epub 2005 Dec 6. PMID: 16332924; PMCID: PMC2672702.
BPSU 18th Annual report 2003 -2004
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