Bloodstream infections with Candida glabrata in a neonatal intensive care unit that uses prophylaxis with fluconazole

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. (C) 2020 Asociacion Espanola de Micologla. Published by Elsevier Espana, S.L.U. All rights reserved.