Abstract 1618 Poster Session II, Sunday, 5/2 (poster 123)

Purpose: Single-institution reports of invasive fungal disease in premature infants have been increasing over the past decade. This study was designed to determine the incidence and clinical manifestations of invasive fungal disease in very low birth weight infants in multiple centers.

Study Design: For one year all infants with a birth weight ≤1500 g (VLBW) admitted to nine neonatal intensive care units were prospectively followed for up to 90 days of age. Information on birth weight (BW), estimated gestational age (EGA), duration of follow-up, and 90 day survival was collected. Additional information was collected on infants who developed invasive fungal disease.

Results: 1147 VLBW infants were admitted to the study centers. Mean EGA and BW were not significantly different between centers. Fifty-six infants developed invasive fungal disease within the first 90 days of life (4.9%). Infants who developed fungal infection had lower mean EGA and BW than those who did not (25.8 wks vs. 28.4 wks and 804gm vs. 1037gm, respectively, p≤0.0001). The frequency of fungal infections among centers ranged from 0% to 15%. Candida albicans was isolated in 50% of fungal infections, C. parapsilosis in 35%, Malassezia furfur in 5%, C. luisitaniae in 4%, and C. glabrata in 2%. In one center C. parapsilosis was isolated from 67% of fungal infections; this center accounted for 95% of C. parapsilosis infections in this study. Fungemia was present in 84% of cases, was the sole site of infection in 75%, and persisted ≥2 days in 23%. Other sites of infection included urinary tract (23% of total; renal involvement found in 5/16 subjects examined), deep cutaneous/soft tissue (4%), peritoneum (14%), and central nervous system (7% of total; 4/18 with CSF evaluations). Invasive fungal infection in the absence of fungemia occurred in 16% of cases. No infant had evidence of retinal involvement (31 examined). All infants received amphotericin B; the majority received amphotericin B alone (84%). The mortality of fungal-infected infants did not significantly differ from the mortality of the entire study population (19.7% vs. 13.7%). Peritoneal involvement was associated with highest mortality (4/8).

Summary: Invasive fungal disease occurred in the first 90 days of life in 5% of VLBW infants. Fungemia was the most frequent manifestation of infection. However, involvement of other organ systems was found in 25% of cases.

Funding for this project was supported in part by an unrestricted educational grant from Pfizer Pharmaceuticals