Evaluation Of Fungal Blood Stream Infections In Premature And Low Birth Weight Neonates, Risk Factors, Antifungal Susceptibly And Outcomes

Abstract

Objective: To determine the incidence, risk factors, antifungal susceptibility and clinical outcomes of fungal bloodstream infections (FBSI) in premature and low birth weight neonates in the NICU.

Study Design: Prospective observational study.

Place and Duration of Study: This study was Conducted in the Paediatric Medicine/Neonatology department of Allied Hospital, Faisalabad during May 2021 to April 2022.

Methodology: The number of neonates enrolled was 398 by using the WHO formula. The inclusion criteria were birth weight <2.5 kg or gestational age <37 weeks and laboratory confirmed fungemia. Demographic, clinical characteristics and risk factors were documented, including prolonged antibiotic therapy, central venous catheterization, parenteral nutrition and mechanical ventilation. Standard microbiological methods were used for the identification of fungal isolates and susceptibility testing was performed in line with the CLSI guidelines. Assessment of the clinical outcomes such as hospital stay, complications and mortality were performed.

Results: The most common isolates were Candida species, mainly C. albicans and C. Para psilosis. Extreme prematurity, low birth weight, prolonged central line use and broad-spectrum antibiotics were significant risk factors. Most isolates were resistant to amphotericin B and echinocandins, and there was some resistance to azoles. FBSIs were associated with longer hospital stay, greater intensive care unit requirements and death.

Conclusion: FBSIs represent a huge risk to premature and low weight neonates. To achieve better outcomes, early recognition and strict infection control and rapid targeted antifungal treatment is crucial.