Association of fungal colonization and invasive disease in very low birth weight infants

Background. Fungi are common pathogens of nosocomial infections in the very low birth weight (VLBW) infants. The purpose of this study was to investigate the fungal colonization rate in VLBW infants and the association between fungal colonization and systemic fungal diseases. Materials. Between January 1, 1996, and December 31, 1996, 116 infants with birth weight <1500 g admitted to the neonatal intensive care unit of Chang Gung Children's Hospital in the first day of life were included in this prospective study. Methods. Cultures from oropharynx, rectum, skin (groin and axilla), bag urine and endotracheal aspirates were obtained in the first 24 h after birth and weekly thereafter throughout their neonatal intensive care unit stay. Medical records were reviewed weekly. Results. Fungal colonization was detected in 25 infants, among whom 17 infants developed colonization by 2 weeks of life. Candida albicans (61%) and Candida parapsilosis (29%) were the 2 most common organisms. The rectum (76%) was the most frequent site of colonization. Factors significantly associated with colonization were prolonged administration of antibiotic therapy, parenteral nutrition and intralipid emulsion. Three of 116 infants developed fungemia, The association between colonization and subsequent fungemia was demonstrated in 1 infant, representing 4% of colonized infants. Conclusion. Fungal colonization was detected in one-fifth of VLBW infants and represents a risk factor for fungemia, Because disease occurred in the absence of apparent colonization, factors other than colonization may contribute to invasive candidiasis.