Neonatal invasive candidiasis in low- and middle-income countries: Data from the NeoOBS study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Cook Aislinn, Ferreras-Antolin Laura, Adhisivam Bethou, Ballot Daynia, Berkley James A, Bernaschi Paola, Carvalheiro Cristina G, Chaikittisuk Napaporn, Chen Yunsheng, Chibabhai Vindana, Chitkara Shweta, Chiurchiu Sara, Chorafa Elisavet, Dien Tran Minh, Dramowski Angela, de Matos Samantha Faria, Feng Jinxing, Jarovsky Daniel, Kaur Ravinder, Khamjakkaew Warunee, Laoyookhong Premsak, Machanja Edwin, Mussi-Pinhata Marisa M, Namiiro Flavia, Natraj Gita, Naziat Hakka, Ngoc Hoang Thi Bich, Ondongo-Ezhet Claude, Preedisripipat Kanchana, Rahman Hafizur, Riddell Amy, Roilides Emmanuel, Russell Neal, Sastry Apurba S, Tasimwa Hannington Baluku, Tongzhen Ji, Wadula Jeannette, Wang Yajuan, Whitelaw Andrew, Wu Dan, Yadav Varsha, Yang Gao, Stohr Wolfgang, Bielicki Julia Anna, Ellis Sally, Warris Adilia, Heath Paul T, Sharland Michael
Аннотация
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.