Status of fungal sepsis among preterm infants in 25 neonatal intensive care units of tertiary hospitals in China.

Xin Cheng Cao; Si Yuan Jiang; Shu Juan LI; Jun Yan Han; Qi Zhou; Meng Meng LI; Rui Miao Bai; Shi Wen Xia; Zu Ming Yang; Jian Fang GE; Bao Quan Zhang; Chuan Zhong Yang; Jing Yuan; Dan Dan Pan; Jing Yun Shi; Xue Feng HU; Zhen Lang Lin; Yang Wang; Li Chun Zeng; Yan Ping Zhu; Qiu Fang Wei; Yan Guo; Ling Chen; Cui Qing Liu; Shan Yu Jiang; Xiao Ying LI; Hui Qing Sun; Yu Jie QI; Ming Yan Hei; Yun Cao

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Status of fungal sepsis among preterm infants in 25 neonatal intensive care units of tertiary hospitals in China.

Author: Xin Cheng CAO ¹ ; Si Yuan JIANG ¹ ; Shu Juan LI ¹ ; Jun Yan HAN ¹ ; Qi ZHOU ¹ ; Meng Meng LI ² ; Rui Miao BAI ³ ; Shi Wen XIA ⁴ ; Zu Ming YANG ⁵ ; Jian Fang GE ⁶ ; Bao Quan ZHANG ⁷ ; Chuan Zhong YANG ⁸ ; Jing YUAN ⁹ ; Dan Dan PAN ¹⁰ ; Jing Yun SHI ¹¹ ; Xue Feng HU ¹² ; Zhen Lang LIN ¹³ ; Yang WANG ¹⁴ ; Li Chun ZENG ¹⁵ ; Yan Ping ZHU ¹⁶ ; Qiu Fang WEI ¹⁷ ; Yan GUO ¹⁸ ; Ling CHEN ¹⁹ ; Cui Qing LIU ²⁰ ; Shan Yu JIANG ²¹ ; Xiao Ying LI ²² ; Hui Qing SUN ²³ ; Yu Jie QI ²⁴ ; Ming Yan HEI ²⁵ ; Yun CAO ¹
Author Information

1. Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
2. Department of Neonatology, Women's Hospital of Nanjing Medical University, Nanjing 210004, China.
3. Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an 200001, China.
4. Department of Neonatology, Maternal and Child Hospital of Hubei Province, Wuhan 430064, China.
5. Department of Neonatology, Suzhou Municipal Hospital, Suzhou 215008, China.
6. Department of Neonatology, Shanxi Children's Hospital, Taiyuan 030006, China.
7. Department of Neonatology, Fujian Maternity and Child Health Hospital, Fuzhou 350005, China.
8. Department of Neonatology, the Affiliated Shenzhen Maternity and Child Healthcare Hospital of Southern Medical University, Shenzhen 518047, China.
9. Department of Neonatology, Qingdao Women and Children's Hospital, Qingdao 266011, China.
10. Department of Neonatology, Guiyang Maternal and Child Health Care Hospital, Guiyang Children's Hospital, Guiyang 550002, China.
11. Department of Neonatology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou 730050, China.
12. Department of Neonatology, Shanghai First Maternal and Infant Hospital, Shanghai 201204, China.
13. Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325088, China.
14. Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
15. Department of Neonatology, Jiangxi Provincial Children's Hospital, Nanchang 330006, China.
16. Department of Neonatology, the First Affiliated Hospital of Xinjiang Medical University, Urumchi 830054, China.
17. Department of Neonatology, Maternity and Child Health Care of Guangxi Zhuang Autonomous Region, Nanning 530002, China.
18. Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China.
19. Department of Neonatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China.
20. Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang 050031, China.
21. Department of Neonatology, Wuxi Maternal and Child Health Care Hospital, Wuxi 214002, China.
22. Department of Neonatology, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan 250022, China.
23. Division of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China.
24. Department of Neonatology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
25. Department of Neonatology, the Third Xiangya Hospital of Central South University, Changsha 410013, China.
Publication Type:Journal Article
MeSH: Infant; Infant, Newborn; Humans; Birth Weight; Intensive Care Units, Neonatal; Retrospective Studies; Tertiary Care Centers; Infant, Extremely Low Birth Weight; Gestational Age; Infant, Extremely Premature; Sepsis/epidemiology*; Retinopathy of Prematurity/epidemiology*; Bronchopulmonary Dysplasia/epidemiology*
From: Chinese Journal of Pediatrics 2023;61(1):29-35
CountryChina
Language:Chinese
Abstract: Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34⁺⁰ weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.