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Infeções fúngicas invasivas numa unidade de cuidados intensivos neonatais de nível III : casuística de 11 anos
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O presente trabalho descreve a epidemiologia das infeções fúngicas invasivas numa Unidade de Cuidados Intensivos Neonatais da região de Lisboa. Foi conduzido um estudo retrospetivo dos anos 2007 a 2017 usando a base de dados clínicos e informação laboratorial da referida unidade. Entre os 3979 recém-nascidos admitidos, foram identificados 14 casos de infeções fúngicas invasivas; destes 14 casos, 7 correspondiam a recém-nascidos com extremo baixo peso. A incidência cumulativa foi de 3,5/1000 (95% CI 2,5/1000 - 4,9/1000) e a incidência entre recém-nascidos de extremo baixo peso foi de 24/1000 (95% CI 16/1000 – 36/1000). Foi efetuada antibioterapia prévia em todos os casos, com antibioterapia de largo espectro em 50% dos casos. O fungo isolado na maioria dos casos foi a Candida parapsilosis e Candida albicans. A terapêutica inicial foi maioritariamente o fluconazol tendo sido alterada para outro fármaco em aproximadamente metade dos casos. A taxa de mortalidade foi de 35,7% (95% CI 16,2% - 61,4%). Dos 14 casos identificados, 2 efetuaram profilaxia antifúngica. É necessária mais investigação para a otimização da identificação dos casos com benefício da profilaxia antifúngica e das estratégias terapêuticas mais eficazes no tratamento das infeções fúngicas invasivas em Neonatologia.
This paper describes the epidemiology of invasive fungal infections in a Neonatal Intensive Care Unit in the Lisbon region. A retrospective study was conducted from 2007 to 2017 using the clinical database and laboratorial information from the mentioned unit. Among the 3979 newborns admitted, 14 cases of invasive fungal infections were identified; Of these 14 cases, 7 corresponded to infants with extremely low birth weight. The cumulative incidence of IFI was 3.5/1000 (95% CI 2.5/1000 - 4.9/1000) and the incidence among extremely low birth weight infants was 24/1000 (95% CI 16/1000 - 36/1000). Previous antibiotic therapy was performed in all cases, with broad spectrum antibiotic therapy in 50% of the cases. The most frequently identified fungus were Candida albicans and Candida parapsilosis. The initial therapy most frequently done was fluconazole and was switched to another drug in approximately half of the cases. The mortality rate was 35.7% (95% CI 16.2% - 61.4%) Of the 14 cases identified, 2 performed antifungal prophylaxis. More research is needed to optimize the identification of cases that benefit from antifungal prophylaxis and to define the most effective therapeutic strategies in the treatment of invasive fungal infections in Neonatology.
This paper describes the epidemiology of invasive fungal infections in a Neonatal Intensive Care Unit in the Lisbon region. A retrospective study was conducted from 2007 to 2017 using the clinical database and laboratorial information from the mentioned unit. Among the 3979 newborns admitted, 14 cases of invasive fungal infections were identified; Of these 14 cases, 7 corresponded to infants with extremely low birth weight. The cumulative incidence of IFI was 3.5/1000 (95% CI 2.5/1000 - 4.9/1000) and the incidence among extremely low birth weight infants was 24/1000 (95% CI 16/1000 - 36/1000). Previous antibiotic therapy was performed in all cases, with broad spectrum antibiotic therapy in 50% of the cases. The most frequently identified fungus were Candida albicans and Candida parapsilosis. The initial therapy most frequently done was fluconazole and was switched to another drug in approximately half of the cases. The mortality rate was 35.7% (95% CI 16.2% - 61.4%) Of the 14 cases identified, 2 performed antifungal prophylaxis. More research is needed to optimize the identification of cases that benefit from antifungal prophylaxis and to define the most effective therapeutic strategies in the treatment of invasive fungal infections in Neonatology.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Infeções fúngicas invasivas Recém-nascidos com extremo baixo peso Fluconazol Pediatria