Invasive fungal infection in very low birth weight infants: National prospective surveillance study

Linda Clerihew ¹, Theresa Lamagni ², Peter Brocklehurst ³ and William McGuire ^4*

¹ Ninewells Hospital, United Kingdom
² Health Protection Agency, United Kingdom
³ University of Oxford, United Kingdom
⁴ ANU Medical School, Australia

^* To whom correspondence should be addressed. E-mail: w.mcguire{at}dundee.ac.uk.

Accepted 14 October 2005

Abstract

Objective: To describe the epidemiology of invasive fungal infection in very low birth weight (VLBW: <1500g) infants in the United Kingdom (UK).

Design: National prospective surveillance study between February 2003 and February 2004 using the British Paediatric Surveillance Unit (BPSU) reporting system reconciled with cases identified through routine laboratory reporting to the Health Protection Agency (England, Wales, and Northern Ireland), the Scottish Centre for Infection and Environmental Health, and the UK Mycology Reference Laboratory.

Results: We identified 94 confirmed cases of invasive fungal infection during the surveillance period giving an estimated annual incidence of 10.0 (95% confidence interval (CI) 8.0 to 12.0) cases per 1000 VLBW live births. 81 (86%) of the infants were of extremely low birth weight (ELBW: <1000 g); estimated incidence 21.1 (95% CI 16.5 to 25.7) per 1000 ELBW live births. Candida species, predominantly C. albicans and C. parapsilosis, were isolated in 93% of cases. Most organisms were isolated from the bloodstream and urinary tract. 41% of infected infants died before 37 weeks' post-conceptional age.

Conclusions: The incidence of invasive fungal infection in VLBW and ELBW infants in the UK is lower than reported in previous studies from tertiary centres in North America and elsewhere. The associated late neonatal and post-neonatal mortality rates are substantially higher than expected in infants without invasive fungal infection. These data may inform decisions about the evaluation and use of anti-fungal infection control strategies.

Keywords: candida, surveillance, very low birth weight

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