Neonatal Candidaemia at Universitas Academic Hospital, Bloemfontein, South Africa

[摘要] BACKGROUND: Candida remains the most common cause of morbidity and mortalityduring the neonatal period. Knowledge of epidemiology of candida species and their antifungalprofile is important to guide empiric therapy. The aim of the study was to characterise andevaluate the antifungal susceptibility of candida species causing neonatal bloodstreaminfections at Universitas Hospital. Vitek 2 automated system is used for yeast identificationand antifungal susceptibility. To determine the accuracy of the results generated, the antifungalsusceptibility results were compared to those generated at the reference laboratory inJohannesburg.METHODS: A retrospective, laboratory based study was conducted over a one year period.Isolates from neonates with candidaemia were identified to species-level and antifungal susceptibility testing was performed. Vitek 2 yeast cards were used for identification andantifungal susceptibility testing. Antifungal susceptibility to fluconazole, amphotericin B, andcaspofungin obtained in our laboratory were compared to those obtained at the referencelaboratory. At the reference laboratory, broth microdilution susceptibility testing wasperformed. Categorical agreement was calculated for susceptibility results.RESULTS: Overall a total of 45 candida species were detected. Non- albicans candidaaccounted for 73% of neonatal candidaemia, with Candida parapsilosis being the mostprevalent (60%). Candida albicans was the second most common isolate (27%).Overall 23 (85 %) of the Candida parapsilosis isolates tested were resistant to fluconazole.When Vitek 2 antifungal susceptibility was compared to broth microdilution performed at the reference laboratory, CA was 100% for amphotericin B and caspofungin. However, for Candida parapsilosis, the CA for fluconazole was 50% with 4 (18%) major errors and 7 (32%)minor errors.CONCLUSIONS:Candida parapsilosis is the major cause of candidaemia amongst the neonate in this study.Amphotericin B is currently the appropriate empirical drug of choice for treatment of thisinfection.

[发布机构] University of the Free State