[Bloodstream infections with Candida glabrata in a neonatal intensive care unit that uses prophylaxis with fluconazole]. / Infección del torrente sanguíneo por Candida glabrata en una unidad de cuidados intensivos neonatales con prescripción de profilaxis con fluconazol.

BACKGROUND: Candida glabrata is an emerging pathogen with the ability to develop tolerance and resistance to azole antifungals, which creates uncertainty about the usefulness of antifungal prophylaxis in newborns. AIMS: The aim of this study was to describe the factors associated with C. glabrata infection in a NICU that uses prophylaxis with fluconazole. METHODS: A case-control study paired by gestational age was designed and conducted at the Civil Hospital of Guadalajara Dr. Juan I. Menchaca. Newborns with C. glabrata infection were studied and for each one a matched control was selected by gestational age. Odds ratios (OR) were estimated with 95% confidence intervals (95% CI) and McNemar test for contrast of hypothesis was applied. RESULTS: Twenty-one infected patients were identified, from whom 66.7% were male; the median gestational age was 31.5 weeks. Increased risk of infection with C. glabrata was observed when there was a prescription of more than one antimicrobial scheme (OR 21, 95% CI, 1.23 - 358.3; p=0.006) and also among patients with surgical comorbidities (OR 8, 95% CI 1.01 - 63.9; p=0.04). During the study period, exposure to fluconazole showed no difference in the risk of infection. CONCLUSIONS: Neonates with more than one antimicrobial regimen and those with surgical comorbidities had a higher risk of C. glabrata infection.

Infección del torrente sanguíneo por Candida glabrata en una unidad de cuidados intensivos neonatales con prescripción de profilaxis con fluconazol / Bloodstream infections with Candida glabrata in a neonatal intensive care unit that uses prophylaxis with fluconazole

ANTECEDENTES: Candida glabrata es un patógeno emergente con capacidad de desarrollar tolerancia y resistencia a los antifúngicos azólicos, lo que genera incertidumbre sobre la utilidad de la profilaxis antifúngica en recién nacidos. OBJETIVOS: El objetivo de este estudio fue describir los factores asociados a la infección por C. glabrata en una UCIN que utiliza la profilaxis con fluconazol. MÉTODOS: Se diseñó un estudio de casos y controles pareado por edad gestacional realizado en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se estudiaron los recién nacidos con infección por C. glabrata y para cada uno se seleccionó un control pareado por edad gestacional; se estimaron razones de momios (RM) con intervalos de confianza del 95% (IC 95%) y prueba de McNemar para contraste de hipótesis. RESULTADOS: Veintiún pacientes presentaron infección, con el 66,7% de ellos de género masculino; la mediana de edad gestacional fue de 31,5 semanas. Se observó mayor riesgo de infección por C. glabrata cuando hubo prescripción de más de un esquema antimicrobiano (RM 21, IC 95% 1,23 - 358,3; p = 0,006) y en pacientes con comorbilidades quirúrgicas (RM 8, IC 95% 1,01 - 63,9; p = 0,04). Durante el periodo de estudio el riesgo de infección no se vio aumentado por la exposición a fluconazol. CONCLUSIONES: Presentaron mayor riesgo de infección por C. glabrata los neonatos con más de un esquema antimicrobiano y aquellos con comorbilidades quirúrgicas

BACKGROUND: Candida glabrata is an emerging pathogen with the ability to develop tolerance and resistance to azole antifungals, which creates uncertainty about the usefulness of antifungal prophylaxis in newborns. AIMS: The aim of this study was to describe the factors associated with C. glabrata infection in a NICU that uses prophylaxis with fluconazole. METHODS: A case-control study paired by gestational age was designed and conducted at the Civil Hospital of Guadalajara Dr. Juan I. Menchaca. Newborns with C. glabrata infection were studied and for each one a matched control was selected by gestational age. Odds ratios (OR) were estimated with 95% confidence intervals (95% CI) and McNemar test for contrast of hypothesis was applied. RESULTS: Twenty-one infected patients were identified, from whom 66.7% were male; the median gestational age was 31.5 weeks. Increased risk of infection with C. glabrata was observed when there was a prescription of more than one antimicrobial scheme (OR 21, 95% CI, 1.23 - 358.3; p = 0.006) and also among patients with surgical comorbidities (OR 8, 95% CI 1.01 - 63.9; p = 0.04). During the study period, exposure to fluconazole showed no difference in the risk of infection. CONCLUSIONS: Neonates with more than one antimicrobial regimen and those with surgical comorbidities had a higher risk of C. glabrata infection