Seventy one percent of fungal endocarditis in neonates associated with CVAD

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Reference:

Pana, Z.D., Dotis, J., Iosifidis, E. and Roilides, E. (2015) Fungal Endocarditis in Neonates: A Review of 71 Cases (1971-2013). Plastic and Reconstructive Surgery. April 30th. [epub ahead of print].

Abstract:

BACKGROUND: Fungal endocarditis (FE) remains an uncommon but life-threatening complication of invasive fungal infections. As data on neonatal FE are scant, we aimed to review all published experience regarding this serious infection.

METHODS: Neonatal FE cases published in PubMed (1971-2013) as single cases or case series were identified using the terms “fungal endocarditis, neonates, cardiac vegetation”. Data on predefined criteria including demographics, predisposing factors, mycology, sites of cardiac involvement, therapy and outcome were collected and analyzed.

RESULTS: The dataset comprised of 71 neonates with FE. Median birth weight was 940 g (IQR 609), median gestational age 27 wks (IQR 6) and median postnatal age at diagnosis 20 d (IQR 20). Ninety-two percent of the patients were premature. Right atrium was the most common vegetation site (63%). Seventy one percent of cases reported were associated with previous central venous catheters. Candida albicans was the most predominant fungal species (59%). Amphotericin B (AMB) monotherapy was used in 42.2% and fluconazole in 2.8%. AMB with flucytosine (25.3%) was the most frequent combined regimen. Surgical treatment was conducted in 28%. Overall mortality was 42.2%. Initiation with combined antifungal treatment was associated with lower mortality than monotherapy (24.2% vs 51.7%, respectively, p=0.036).

CONCLUSIONS: Neonatal FE most frequently occurs in very premature infants and is associated with central venous catheters. Candida albicans is the predominant fungus. Although outcome has been dismal, it may be improved with combined antifungal therapy.

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