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P1 INVASIVE FUNGAL INFECTION IN VLBW INFANTS: NATIONAL SURVEILLANCE STUDY

L. Clerihew1, T. Lamagni2, P. Brocklehurst3, A. Balfour4, W. McGuire1 on behalf of the UK Neonatal Fungal Infection Surveillance Group 1Tayside Institute of Child Health, Ninewells Hospital, Dundee; 2Health Protection Agency (CDSC), London; 3National Perinatal Epidemiology Unit, Institute of Health Sciences, Oxford; 4Royal Hospital for Sick Children, Glasgow, United Kingdom

Background and Aims: Invasive fungal infection is an increasingly common cause of mortality and morbidity in very low birth weight (VLBW: <1500 g) infants. The development and evaluation of improved strategies for treatment and prevention would be assisted by the availability of national epidemiological data in an unselected population of VLBW infants.

Methods: National prospective surveillance study; each month paediatricians notify cases using the British Paediatric Surveillance Unit (BPSU) reporting system. In parallel, the Health Protection Agency and Scottish Centre for Infection and Environmental Health identify cases via laboratory surveillance. These are reconciled with BPSU reports to validate case ascertainment.

Findings: 38 confirmed cases of invasive fungal infection in VLBW infants were identified during the first six months of the study, consistent with an incidence of ~10/1000 live births. The median age at diagnosis was 11 days (range 1–126 days), and the median birth weight 800 g (520–1200 g). 34 (89%) of the infants were of extremely low birth weight (ELBW: <1000 g), giving an estimated incidence of 46/1000 live births in this population. Candida albicans was identified in 55% of cases, and C parapsilosis in 23%. The organisms were isolated from blood in 73% of cases, central line tips in 53%, and urine in 23%. 3 infants (8%) had evidence of meningitis. 36% of cases had received prophylactic antifungal therapy. The antifungal treatment regimens used were: amphotericin B (18%); liposomal amphotericin (58%); fluconazole (44%); and flucytosine …

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