Fungal Gut Colonization with Candida or Pityrosporum sp. and Serum Candida Antigen in Preterm Neonates with Very Low Birth Weights

Abstract

To evaluate the diagnostic value of gut colonization by yeasts and of candida antigen in serum for predicting fungal infection in very premature neonates, faecal and serum samples were obtained biweekly from 27 newborn babies treated at our neonatal intensive care unit. Altogether 82 sets of serum and faecal samples were obtained. 17 babies were followed for ≥4 weeks. Blood cultures, both by routine and lysis centrifugation techniques, were performed for bacteria and fungi if infection was suspected. All children were given systemic broadspectrum antibiotic treatment. Five of the children died, all without evidence of fungal infection. No systemic antifungal treatments were given.

Quantitative faecal cultures demonstrated Candida albicans in 3 (11%) (10³-10⁵ colony forming units/g) and Pityrosporum sp. in 8 (30%) of the preterm neonates. Candida antigen in titre 4 was detected in 1/82 serum samples. The child subsequently died with no other evidence of Candida infection. in 56 full term neonates treated at the intensive care unit during the same period and tested by 1 set of samples, faecal colonization with Candida sp. was detected in 2 (4%) and with Pityrosporum sp. in 4 (15%). None were positive for candida antigen.

Fungal gut colonization did not lead to clinical infection in the preterm neonates studied. The false positivity rate of the Candida antigen test was low (0.7%). The predictive value of the test could not be determined in this study group with no systemic fungal infections. The role of pityrosporum as an inducer of neonatal infections remains to be evaluated.