A Retrospective Cohort Study On The Invasive Fungal Infection In The Preterm Infants

Objective:Invasive fungal infection has become an important problem in the neonatal intensive care unit (NICU),especially among the preterm infant. Its steadily increasing incidence and its strong association with significant morbidity and mortality raises people's awareness.However,the disease's early manifestation is atypical,and the standard test for diagnosis is time-consuming and insensitive,so the timely diagnosis and the proper treatment remains a major challenge.Therefore,it's important to understand the risk factors of invasive fungal infection in preterm infant,to regonize who has high-risk factors,then to take some efficient prevention strategies in these patients at high-risk for Candida infection.Material and methods:A historical cohort study of invasive candidiasis was conducted in the neonatal intensive care unit of First Hospital of JiLin University,between 1st January in 2010 and 28th February in 2011.Invasive fungal infection was defined defined as positive cultures from normally sterile body fluid or site.We collected the information,all data was analyzed with non-conditional Logistic regression.Results:1.During this period,77 neonates developed invasive candidiasis, resulting in an overall incidence of 6.77%.2.The overall mortality was 28.9%, The median length of hospital stay was33(22,47).In hospital time and in mortality of invasive fungal infection group were obviously higher than that in control group(P<0.05).3.The Candida spp. identified by culture:C. glabrata (47%),C. Albicans(41.5%), C. tropicalis (4%),C parapsilosis(2.5%),C. lusitaniae(2.5%), C. famata(2.5%).4.x2 test was used to compare the possible confoundings.Statistical significance were all set at p<0.01,Significant univariate predictors included:PICC(RR=9.932),broad-spectrum antibiotics (RR=8.821),intubution(RR=7.961),the CMV infection(RR=5.646),the bacterial infection(RR=4.829),gestation age(RR=4.105),Fluconazole for prophylaxis (RR=4.087),birthweight(RR=3.563),Corticosteroid therapy (RR=2.799). 5.Logistic regression analyses were conducted,the independent risk factors include:The use of broad-spectrum antimicrobial agents(OR=2.839, P=0.026),the presence of central venous catheters (OR=4.983,P<0.001) and intubution(OR=2.811,P=0.002),and the primary infection with cytomegalovirus (OR=4.088,P<0.001).Conclusions:.1.The incidence of the invasive fungal infection was 6.77%, which accounted for 55.79% of sepsis in preterm infants.2.The invasive fungal infection was association with the significant high mortalty,responsible for the long-stay in hospital.3.In our center,the most frequently isolated species were C.glabrata and C. Albicans.4.After the main multivariate of statistical analysis, the use of broad-spectrum antimicrobial agents,the presence of central venous catheters and intubution,and the primary infection with human cytomegalovirus (HCMV),are the independence high risk factors of the invasive fungal infection in the preterm infants.