TY - JOUR
T1 - Early mannan detection in bronchoalveolar lavage fluid with preemptive treatment reduces the incidence of invasive Candida infections in preterm infants
AU - Posteraro, Brunella
AU - Sanguinetti, Maurizio
AU - Boccia, Stefania
AU - De Feo, Emmma
AU - La Sorda, Marilena
AU - Tana, Milena
AU - Tirone, Chiara
AU - Aurilia, Claudia
AU - Vendettuoli, Valentina
AU - Fadda, Giovanni
AU - Romagnoli, Costantino
AU - Vento, Giovanni
PY - 2010/9
Y1 - 2010/9
N2 - 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.
AB - 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.
KW - antifungal treatment
KW - invasive candidiasis
KW - mannan detection
KW - neonatal intensive care unit
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U2 - 10.1097/INF.0b013e3181da866d
DO - 10.1097/INF.0b013e3181da866d
M3 - Article
C2 - 20357693
AN - SCOPUS:77955981328
VL - 29
SP - 844
EP - 848
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
SN - 0891-3668
IS - 9
ER -