A non-albicans Candida fungemia in very low birth weight infants in the neonatal intensive care unit of an “AAA” tertiary hospital in Shenzhen, China

We explored the clinical characteristics, risk factors, pathogen species spectrum and antifungal susceptibility of non-albicans Candida fungemia in very low birth weight (VLBW) infants in a neonatal intensive care unit (NICU). The retrospective study was conducted on 492 VLBW infants who were admitted to NICU at the Maternal and Child Care Hospital in Shenzhen, China from January 2008 to December 2011. Among them, 21 VLBW infants (4.27%) were diagnosed with fungemia. All of these infants received parenteral hyperalimentation therapy. Among the infants with fungemia, 12 received endotracheal intubation, 19 received a peripherally inserted central catheter and all were treated with antibiotics. The main clinical manifestations in the infants were abrupt fever, pallor, mottling, cold clammy skin, tachycardia or bradycardia,tachypnea or apnea, cyanosis, abdominal distention, poor feeding and lethargy. The pathogen species isolated from the infants were nonalbicans Candida: specifically, Candida tropicalis (52.4%), and C. parapsilosis (47.6%). In the 21 infants with fungemia, fluconazole was used empirically from the onset of the disease. Among these infants, four were treated with itraconazole as a replacement therapy for fluconazole. The outcome was that of the 21 infants with fungemia, 19 were cured while two died. Fluconazole and itraconazole susceptibility in the 21 Candida isolates was 90.48% and 100%, respectively. The incidence of fungemia in VLBW infants remains quite high in southern China. Fluconazole and itraconazole should be considered as a first choice therapy for timely fungemia treatment.