Epidemiology and clinical presentation of neonatal fungal sepsis in intensive care units of Pediatric clinic Tuzla

Introduction: Standing advances in neonatology increased survival of premature infants with the use of invasive procedures, which increases risk of infection and fungal sepsis. Risk factors for fungal sepsis are extensively studied. Candida is dominant, but there is increase in resistant C. non-albicans species. Mortality is high and requires timely suspicion of fungal sepsis, and adequate treatment to counteract the fatal outcome.Objectives: To analyze the clinical and laboratory characteristics of neonates, treated in the neonatal intensive care unit because of microbiologically proven fungal sepsis.Subjects and Methods:The restrospective observational study included 48 consecutive neonates, treated in Iintensive care unit of Pediatric Clinic Tuzla during three-year period (2016-2018), those with proven fungal sepsis, confirmed by positive blood culture. We analyzed perinatal history, clinical and laboratory presentation of disease, length of treatment and outcome. Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution.Results: Of the total treated 921 neonates, confirmed fungal sepsis were found in 48 infants (5.2%), evenly distributed by gender. Of perinatal risk factors, confirmed the prematurity and low birth weight, and significant were the presence of umbilical venous catheter, parenteral nutrition, longer antibiotic therapy and mechanical ventilation. Clinically, fungal sepsis manifested as late sepsis with respiratory higher requirements, lethargy, feeding difficulties and abdominal distension. The most common laboratory abnormalities were increased CRP, leukocytosis and thrombocytopenia. Outcome: 44 neonates (91.7%) survived, while 4 neonates (8.3%) died. Antifungal therapy lasted 20.6 ± 6 days, and intensive treatment 38.2 ± 23.2 days. All isolates were Candida species, in vitro without resistance. In 8 neonates (16.7%) recorded a slight toxic hepatitis.Conclusion: Recovery of neonates with fungal sepsis depend on timely clinical suspicion, adequate treatment and monitoring. Antifungal susceptibility is also important, which requires monitoring of local epidemiological data to improve treatment.