Early mannan detection in bronchoalveolar lavage fluid with preemptive treatment reduces the incidence of invasive Candida infections in preterm infants

Brunella Posteraro, Maurizio Sanguinetti, Stefania Boccia, Emmma De Feo, Marilena La Sorda, Milena Tana, Chiara Tirone, Claudia Aurilia, Valentina Vendettuoli, Giovanni Fadda, Costantino Romagnoli, Giovanni Vento

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Candida colonization is an important predictor for development of invasive fungal infection (IFI). We investigated whether early detection of Candida mannan (Mn) in bronchoalveolar lavage fluid (BALF) reduces IFI among preterm infants. Methods: We conducted an observational study of infants with gestational age of ≤28 weeks, where a group undergoing Candida surveillance cultures (pre-Mn detection group) was compared with a group defined after the initiation of routine use of Candida Mn detection in BALF (Mn detection group). Antifungal treatment was started based on positive microbiologic (surveillance culture or Mn-antigen assay) results. Results: No significant differences were detected when the groups were compared for several predictors of IFI. IFI was observed for 12 (23%) of 51 infants in the pre-Mn detection group, and for 0 (0%) of 29 infants in the Mn detection group (P = 0.003). Surveillance cultures in the pre-Mn detection group became positive at 15.0 ± 7.2 days after birth, whereas the mean age at time of positive Mn antigen results in the Mn detection group was 4.3 ± 3.1 days (P <0.0001). Among 16 infants positive for surveillance cultures, 12 (75%) developed IFI (P <0.0001). Conclusions: This study suggests that Candida Mn detection in BALF may be useful for earlier identification and preemptive therapy targeting preterm infants at high risk of IFI.

Original languageEnglish
Pages (from-to)844-848
Number of pages5
JournalPediatric Infectious Disease Journal
Volume29
Issue number9
DOIs
Publication statusPublished - Sep 2010

Keywords

  • antifungal treatment
  • invasive candidiasis
  • mannan detection
  • neonatal intensive care unit

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases
  • Microbiology (medical)

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