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UK enhanced surveillance of invasive fungal infections in very low birth weight infants

Abstract number: 902_p994

Lamagni T.

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Objectives:

Preliminary analyses from enhanced surveillance of invasive fungal infections in very low birth weight (VLBW) infants were performed to estimate disease burden, short-term outcome and microbiological characteristics of causative organisms.

Methods:

Prospective enhanced surveillance of invasive fungal infections in VLBW (<1500 g) infants began in February 2003, with cases defined as meeting of one or more of the following diagnostic criteria: (1) culture from a sterile site – CSF, blood (peripheral sample), urine (supra-pubic aspirate or in–out catheter sample), bone/joint, peritoneal or pleural space; (2) pathognomonic findings on ophthalmological examination; (3) pathognomonic findings on renal ultrasound examination; and (4) autopsy diagnosis of invasive fungal infection. Cases were identified through three separate surveillance schemes: monthly notifications from paediatricians to the British Paediatric Surveillance Unit; continuous reports from microbiology laboratories to the Communicable Disease Surveillance Centre (England) and Scottish Centre for Infection and Environmental Health (Scotland). Reports from the three systems were reconciled and analysed. Rates were calculated using Office for National Statistics total live birth estimates.

Results:

Between February and July, 38 confirmed cases of invasive fungal infection in VLBW infants were reported, 10.02/1000 births of VLBW. Median age at diagnosis was 11 days (range 1–126) and birth weight 800 (520–1200) g. Thirty-four of the 38 infants were of extremely low birth weight (<1000 g). Candida albicans was the most common pathogen, found in 55% of cases, and C. parapsilosis in 23%. Organisms were most commonly isolated from blood (73%), followed by urine (23%), CSF (8%) and central line tips (53%). Just over a third of cases (36%) had received prophylactic antifungal therapy. One case of drug resistance was identified during this period (fluconazole resistance in a non-albicans Candida spp.). Of the 32 infants for whom outcome data were available, 22 were alive at 37 weeks post-conceptional age.

Conclusion:

Preliminary findings from enhanced surveillance suggest an incidence of invasive mycoses in VLBW infants of one in 100. As per adult cases, C. albicans was the most common fungal pathogen involved, although C. parapsilosis was relatively more common than in adults. The majority of cases occurred in extremely low birth weight infants, and mortality was found to be high.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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