PATTERNS OF FUNGAL COLONIZATION IN VERY LOW BIRTH-WEIGHT (VLBW) INFANTS

Abstract

We previously documented fungal sepsis in 4% of our VLBW (<1500g)infants, with a 79% mortality. To determine sources, timing and sites of acquisition in this high risk population, weekly oropharyngeal, rectal, groin and, if intubated, endotracheal(ET) Sabouraud cultures were obtained from 115 VLBW infants, plus equipment and staff. 4.3% of infants were colonized(col.)at birth, rising to 28% at lwk, peaking at 39% ⩾2wks. The sites at which col. were first detected varied with age at col: Initially

GI/respiratory, later, skin. No fungi were cultured from 62 umbilical/central lines, 14 chest tubes, 157 breast milks, 20 personnel hands, 106 respiratory tubings or 183 isolettes. Candida albicans was the major fungus grown at birth and at lwk(66.7%), but no new col. occurred >2wks. Infants col. later grew C.parapsilosis(37.5%)or a yeast unable to be grown for identification (37.5%). C.albicans(60%)and C.parapsilosis(40%)grew from 7.9% of ET aspirates, with 60% of them present from birth. 2 infants, 6.5% of col. infants, developed systemic C.albicans infections (1 meningitis, endophthalmitis; 1 peritonitis). We conclude that col. by C.albicans, the major pathogen in this population, occurs in the first wk of life, with both GI and respiratory contamination. Attempts to prevent systemic disease must take these data into account.

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