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Fungal Endocarditis in Neonates: A Review of Seventy-one Cases (1971–2013)

Pana, Zoe Dorothea MD, MSc, PhD*; Dotis, Jhn MD, PhD†ο; Iosifidis, Elias MD, MSc, PhD*; Roilides, Emmanuel MD, PhD, FIDSA*

The Pediatric Infectious Disease Journal: August 2015 - Volume 34 - Issue 8 - p 803–808
doi: 10.1097/INF.0000000000000735
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Background: Fungal endocarditis (FE) remains an uncommon but life-threatening complication of invasive fungal infections. As data on neonatal FE are scant, we aimed to review all published experience regarding this serious infection.

Methods: Neonatal FE cases published in PubMed (1971–2013) as single cases, or case series were identified using the terms “fungal endocarditis, neonates and cardiac vegetation.” Data on predefined criteria including demographics, predisposing factors, mycology, sites of cardiac involvement, therapy and outcome were collected and analyzed.

Results: The dataset comprised 71 neonates with FE. Median birth weight was 940 g [interquartile range (IQR): 609], median gestational age 27 weeks (IQR: 6) and median postnatal age at diagnosis 20 days (IQR: 20). Ninety-two percent of the patients were premature. Right atrium was the most common vegetation site (63%). Seventy-one percent of the cases reported were associated with previous central venous catheters. Candida albicans was the most predominant fungal species (59%). Amphotericin B monotherapy was used in 42.2% and fluconazole in 2.8%. Amphotericin B with flucytosine (25.3%) was the most frequent combined regimen. Surgical treatment was conducted in 28%. Overall mortality was 42.2%. Initiation with combined antifungal treatment was associated with lower mortality than monotherapy (24.2% vs. 51.7%, respectively, P = 0.036).

Conclusions: Neonatal FE most frequently occurs in very premature infants and is associated with central venous catheters. C. albicans is the predominant fungus. Although outcome has been dismal, it may be improved with combined antifungal therapy.

Supplemental Digital Content is available in the text.

From the *Infectious Diseases Unit, 3rd Department of Pediatrics, and 1st Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.

Accepted for publication January 16, 2015.

The authors have no funding or conflicts of interest to disclose.

Partially presented at the 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 10–13, 2013; Denver, Colorado, abstract number 1778.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Emmanuel Roilides, MD, PhD, Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University, Hippokration Hospital, Konstantinoupoleos 49, GR-546 42 Thessaloniki, Greece. E-mail: roilides@med.auth.gr.

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