Article Data

  • Views 1607
  • Dowloads 127

Original Research

Open Access

The burden of Candida species colonization in NICU patients: a colonization surveillance study

  • VIRGA A1

1Department of Sciences for Health Promotion and Maternal-Infant Care “G. D’Alessandro,” Hygiene Section University of Palermo

DOI: 10.22514/SV132.112017.10 Vol.13,Issue 2,November 2017 pp.71-75

Published: 06 November 2017

*Corresponding Author(s): GERACI DM E-mail:


Fungal infections are an important cause of morbidity and mortality in neonatal intensive care units (NICUs). The identifi-cation of specific risk factors supports pre-vention of candidemia in neonates. Effec-tive prophylactic strategies have recently become available, but the identification and adequate management of high-risk in-fants is still a priority. Prior colonization is a key risk factor for candidemia. For this reason, surveillance studies to monitor in-cidence, species distribution, and antifun-gal susceptibility profiles, are mandatory. Among 520 infants admitted to our NICU between January 2013 and December 2014, 472 (90.77%) were included in the study. Forty-eight out of 472 (10.17%) pa-tients tested positive for Candida spp. (C.), at least on one occasion. All the colonized patients tested positive for the rectal swab, whereas 7 patients also tested positive for the nasal swab. Fifteen out of 472 patients (3.18%) had more than one positive rec-tal or nasal swab during their NICU stay. Moreover, 9 out of 15 patients tested nega-tive at the first sampling, suggesting they acquired Candida spp. during their stay. Twenty-five of forty-eight (52.1%) colo-nized patients carried C.albicans and 15/48 (31.25%) C.parapsilosis. We identified as risk factors for Candida spp. colonization: antibiotic therapy, parenteral nutrition, the use of a central venous catheter, and nasogastric tube. Our experience suggests that effective microbiological surveillance can allow for implementing proper, effec-tive and timely control measures in a high-risk setting.


Candida, surveillance, NICU

Cite and Share

GERACI DM,VIRGA A,VECCHIO D,GRAZIANO G,SAPORITO L,INSINGA V,MAIDA CM,MAMMINA C,GIUFFRÈ M. The burden of Candida species colonization in NICU patients: a colonization surveillance study. Signa Vitae. 2017. 13(2);71-75.


1. Costa-de-Oliveira S, Pina-Vaz C, Mendonça D, Rodrigues AG. A first Portuguese epidemiological survey of fungaemia in a univer-sity hospital. Eur J Clin Microbio 2008;l27:365–74.

2. Rangel-Frausto MS, Wiblin T, Blumberg HM, Saiman L, Patterson J, Rinaldi M, Wenzel RP. National epidemiology of mycoses survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin Infect Dis 1999;29.2:253-8.

3. Weese-mayer DE, Fondriest DW, Brouillette RT, Shulman ST. Risk factors associated with candidemia in the neonatal intensive care unit: a case-control study. Pediatr Infect Dis J 1987;6.2:190-6.

4. Saiman L, Ludington E, Pfaller M, Rangel-Frausto S, Wiblin RT, Dawson J, Wenzel RP. Risk factors for candidemia in neonatal inten-sive care unit patients. Pediatr Infect Dis J 2000;19.4:319-24.

5. Cole GT, Halaiva AA, Anaissie E. The role of the gastrointestinal tract in hematogenous candidiasis: from the laboratory to the bed-side. Clin Infect Dis 1996; 22(suppl 2):S73–88.

6. Kicklighter SD, Springer SC, Cox T, Hulsey TC, Turner RB. Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant. Pediatrics 2001;107.2:293-8.

7. Kaufman DA. Fluconazole prophylaxis: can we eliminate invasive Candida infections in the neonatal ICU? Curr Opin Pediatr 2008;20.3:332-40.

8. Kumar ARUN, Yadav APARNA, Gathwala GEETA, Gagneja DEEP, Chaudhary U, Gill PS, Gagneja D. Study of risk factors for can-dida species colonisation of neonatal intensive care unit patient. Int J Pharm Bio Sci 2012;3:193-9.

9. Bendel CM. Colonization and epithelial adhesion in the pathogenesis of neonatal candidiasis. Semin Perinatol 2003;27.5:357-64.

10. Giuffrè M, Amodio E, Bonura C, Geraci DM, Saporito L, Ortolano R, et al. Methicillin-resistant Staphylococcus aureus nasal coloni-zation in a level III neonatal intensive care unit: Incidence and risk factors. Am J Infect Contr 2015;43(5):476-81.

11. Geraci DM, Giuffrè M, Bonura C, Matranga D, Aleo A, Saporito L, et al. Methicillin-resistant Staphylococcus aureus colonization: A three-year prospective study in a neonatal intensive care unit in Italy. PLoS ONE 2014;9(2):e87760.

12. Giuffre M, Geraci DM, Bonura C, Saporito L, Graziano G, Insinga V, et al. The increasing challenge of multidrug-resistant gram-neg-ative bacilli: results of a 5-year active surveillance program in a neonatal intensive care unit. Medicine (United States) 2016;95(10): e3016.

13. Huang YC, Li CC, Lin TY, Lien RI, Chou YH, Wu JL, Hsueh C. Association of fungal colonization and invasive disease in very low birth weight infants. Pediatr Infect Dis J 1998;17.9:819-22.

14. Baley JE, Kliegman RM, Boxerbaum B. Fungal colonization in the very low birth weight infant. Pediatrics 1986;78:225-32.

15. El-Mohandes AE, Johnson-Robbins L, Keiser JF, et al. Incidence of Candida parapsilosis, colonization in an intensive care nursery population and its association with invasive fungal disease. Pediatr Infect Dis J 1994;13:520—524.

16. Kicklighter SD, Springer SC, Cox T, HulseyTC, Turner RB. Fluconazole for prophylaxis against candidal rectal colonization in the very low birth weight infant. Pediatrics 2001;107.2:293-8.

17. Manzoni P, Farina D, Leonessa M, d’Oulx EA, Galletto P, Mostert M, Gomirato G. Risk factors for progression to invasive fungal infection in preterm neonates with fungal colonization. Pediatrics 2006;118.6:2359-64.

18. Singhi S, Rao DSR, Chakrabarti A. Candida colonization and candidemia in a pediatric intensive care unit. Pediatr Crit Care Med 2008; 9(1), 91-95.

19. Carey AJ, Saiman L, Polin RA. Hospital-acquired infections in the NICU: epidemiology for the new millennium. Clin Perinatol 2008;35.1:223-49.

20. Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M, Donowitz LG. Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N Engl J Med 2001;345.23:1660-6.

21. Marr KA, Seidel K, White TC, Bowden RA. Candidemia in allogeneic blood and marrow transplant recipients: evolution of risk fac-tors after the adoption of prophylactic fluconazole. J Infect Dis 2000;181.1:309-16.

22. Vardakas KZ, Michalopoulos A, Falagas ME. Fluconazole versus itraconazole for antifungal prophylaxis in neutropenic patients with haematological malignancies: a meta‐analysis of randomised‐controlled trials. Br J Haematol 2005;131.1:22-8.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time