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Update on the management of Candida infections in preterm neonates
  1. P Manzoni1,
  2. M Mostert2,
  3. E Castagnola3
  1. 1Department of Neonatology and NICU, S. Anna Hospital, Torino, Italy
  2. 2Department of Pediatrics, University of Torino, Torino, Italy
  3. 3Infectious Disease Unit, Istituto Giannina Gaslini, Genova, Italy
  1. Correspondence to Dr Paolo Manzoni, Department of Neonatology and NICU, Sant’ Anna Hospital, Azienda Ospedaliera Regina Margherita–Sant’ Anna, C. Spezia 60, 10126 Torino, Italy; paolomanzoni{at}hotmail.com

Abstract

Invasive fungal infections in preterm neonates in the neonatal intensive care unit are predominantly caused by Candida spp, and have a high burden of morbidity and mortality. Effective prophylactic strategies have recently become available, but the identification of the best possible strategies to manage high-risk infants is still a priority. Choice and use of appropriate antifungal drugs needs careful assessment of neonatal characteristics, the epidemiology and drug pharmacokinetics. Ideally, antifungal drugs for preterm neonates should target fungal bio-films, prevent or effectively treat end-organ localisations, be active against fluconazole-resistant Candida species, and have reliable safety and tolerability profiles. The paper reviews the state-of-the-art in the area of neonatal fungal infections, and addresses some open questions related to the best possible prophylactic and therapeutic strategies to be implemented in such unique patients.

  • Neonatology
  • Infectious Diseases
  • Candida
  • Preterm
  • Fluconazole

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