Fungal Endocarditis in Neonates: Systematic Review of 70 Cases

Ref ID: 19273

Author:

Z. D. Pana, I. Dotis, E. Roilides

Author address:

Aristotle Univ., Thessaloniki, GREECE

Full conference title:

53rd Interscience Conference on Antimicrobial Agents and Chemotherapy

Date: 10 September 2014

Abstract:

Background: Fungal endocarditis (FE) remains an uncommon but life-threatening complication of neonatal invasive fungal infections. As data on FE are very limited, we aimed to review all published experience regarding neonatal FE. Methods: Review of all neonatal FE cases published in PubMed (1971-2012) as single cases or case series. The terms “œfungal endocarditis, neonates, cardiac vegetation” were used. Demographics, fungal species, cardiac involvement, predisposing factors, therapy and outcome were analyzed. Each parameter was expressed as median value with interquartile range (IQR). For comparisons between variables Fisher exact test was used. Statistical significance was assigned to two-sided p values less than 0.05 (SPSS ed.13). Results: Our dataset comprised of 70 neonates with FE (males 54.8%). Median birth weight (BW) was 940 g (IQR 631), median gestational age (GA) was 27 wk (IQR 7) and median postnatal age at diagnosis was 20 d (IQR 20). From them, 91.5% were premature (GA<=37 wks) and 56.1% extreme low BW (<1000 g) neonates, respectively. The right atrium (RA) was the most common cardiac vegetation site (65.7%). All cases more recently reported were associated with umbilical catheters. Among fungal species, Candida predominated (97.1%) [C. albicans (61.4%), C. parapsilosis (21.4%), C. tropicalis (2.9%), unidentified Candida spp. (7.1%), other fungal species (7.1%)]. Two FE cases were due to Saccharomyces cerevisiae and Phialemonium obovatum each. Overall mortality rate was 41.4%. Various antifungal regimens [amphotericin B (AMB), fluconazole (FLU), AMB + flucytosine (5-FC), AMB + FLU, AMB + caspofungin (CAS), AMB + 5-FC + CAS, AMB + recombinant tissue plasminogen factor] were recorded as initial therapy. AMB monotherapy was used in 40.3% and FLU in 11.3%. The most frequent combination regimen was AMB + 5-FC (27.4%) followed by AMB + FLU (9.7%) and AMB + CAS (4.8%). Two neonates received AMB + rTPA with favorable outcome. Initial combination antifungal treatment was associated with more improved outcome as compared to monotherapy (p=0.048). Surgical treatment was recorded in 31.7%. Conclusions: Neonatal FE most frequently occurs in very premature infants and is associated with umbilical catheters. Candida albicansand C. parapsilosis are the predominant fungi causing neonatal FE. Mortality is high and improved outcome may be related with combination antifungal therapy.

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Conference Year: 2013

Link to conference website: NULL

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