Cook, A;
Ferreras-Antolin, L;
Adhisivam, B;
Ballot, D;
Berkley, JA;
Bernaschi, P;
Carvalheiro, CG;
Chaikittisuk, N;
Chen, Y;
Chibabhai, V;
et al.
Cook, A; Ferreras-Antolin, L; Adhisivam, B; Ballot, D; Berkley, JA; Bernaschi, P; Carvalheiro, CG; Chaikittisuk, N; Chen, Y; Chibabhai, V; Chitkara, S; Chiurchiu, S; Chorafa, E; Dien, TM; Dramowski, A; de Matos, SF; Feng, J; Jarovsky, D; Kaur, R; Khamjakkaew, W; Laoyookhong, P; Machanja, E; Mussi-Pinhata, MM; Namiiro, F; Natraj, G; Naziat, H; Ngoc, HTB; Ondongo-Ezhet, C; Preedisripipat, K; Rahman, H; Riddell, A; Roilides, E; Russell, N; Sastry, AS; Tasimwa, HB; Tongzhen, J; Wadula, J; Wang, Y; Whitelaw, A; Wu, D; Yadav, V; Yang, G; Stohr, W; Bielicki, JA; Ellis, S; Warris, A; Heath, PT; Sharland, M
(2023)
Neonatal invasive candidiasis in low- and middle-income countries: Data from the NeoOBS study.
Med Mycol, 61 (3).
myad010.
ISSN 1460-2709
https://doi.org/10.1093/mmy/myad010
SGUL Authors: Cook, Aislinn Jane
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Abstract
Neonatal invasive candidiasis (NIC) has significant morbidity and mortality. Reports have shown a different profile of those neonates affected with NIC and of fluconazole-resistant Candida spp. isolates in low- and middle-income countries (LMICs) compared to high-income countries (HICs). We describe the epidemiology, Candida spp. distribution, treatment, and outcomes of neonates with NIC from LMICs enrolled in a global, prospective, longitudinal, observational cohort study (NeoOBS) of hospitalized infants <60 days postnatal age with sepsis (August 2018-February 2021). A total of 127 neonates from 14 hospitals in 8 countries with Candida spp. isolated from blood culture were included. Median gestational age of affected neonates was 30 weeks (IQR: 28-34), and median birth weight was 1270 gr (interquartile range [IQR]: 990-1692). Only a minority had high-risk criteria, such as being born <28 weeks, 19% (24/127), or birth weight <1000 gr, 27% (34/127). The most common Candida species were C. albicans (n = 45, 35%), C. parapsilosis (n = 38, 30%), and Candida auris (n = 18, 14%). The majority of C. albicans isolates were fluconazole susceptible, whereas 59% of C. parapsilosis isolates were fluconazole-resistant. Amphotericin B was the most common antifungal used [74% (78/105)], followed by fluconazole [22% (23/105)]. Death by day 28 post-enrollment was 22% (28/127). To our knowledge, this is the largest multi-country cohort of NIC in LMICs. Most of the neonates would not have been considered at high risk for NIC in HICs. A substantial proportion of isolates was resistant to first choice fluconazole. Understanding the burden of NIC in LMIC is essential to guide future research and treatment guidelines.
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