Background and aims Recent reports indicate that the incidence of Candida ssp. bloodstream infection (BSI) is decreasing among NICU patients, and is associated with antifungal prophylaxis and the dwell time of peripherally inserted central catheters (PICCs). This study describes the epidemiology of invasive fungal infections in a single NICU.
Methods We conducted a retrospective study of invasive candidiasis occurring in 6730 infants admitted to our NICU. Positive fungal blood cultures were identified through searching our microbiology database.
Results From a total of 2637 blood cultures performed during the study period, there were 6 (<0.1%) Candida spp. (Candida albicans n = 5, Candida lusitaniae n = 1) BSIs reported. In 3 cases premature rupture of membranes was observed, and in 2 cases maternal vaginal smears were positive for Candida ssp. All Patients with Candida albicans BSI (Gestational age 24.3 to 27.0 weeks) had PICCs, while blood cultures became positive between day 1 to 10. 1 patient died on day 13. Treatment consisted in Fluconazole (67%), Amphotericin B (33%), and Caspofungin (17%), partially combined. Persistent positive Candida BSIs were not reported. Systemic antifungal prophylaxis is not implemented at our NICU. During the same period 402 positive fungal cultures in 198 patients were documented from other sources.
Conclusions Even without prophylactic systemic antifungal therapy at our NICU the observed rate of Candida BSIs is low but in line with other studies. Prenatal vaginal smears might help to detect ELBW infants being at high risk for candidemia.