Surveillance and Prevention of Fungal Infections in the Neonatal Intensive Care Unit

Introduction: Advances in the care of preterm neonates and newborns with congenital anomalies requiring hospitalization in intensive care units (ICU) have led to an increased population susceptible to healthcare-associated infections (HAIs), including those of fungal etiology. HAIs in neonatal ICUs are caused by microorganisms resistant to antibacterial and antifungal agents. Contributing factors include low birth weight, severe comorbidities, prolonged hospital stays, prolonged use of invasive devices, aggressive antibacterial therapy, and prophylactic antifungal therapy. In recent decades, fungal infections have become a significant cause of late-onset neonatal sepsis. Methods: A retrospective analysis was conducted on cases of fungal infection in neonatal ICU and cardiothoracic ICU at the University clinic from 2021 to 2023 in St.Petersburg, Russia. Both cases of invasive mycosis and colonization were evaluated. Results: Among 1418 patients, fungal infection was detected in 77 individuals (5.4%). More than half of all cases were associated with Candida non-albicans (55.8%), Candida albicans isolated in 28.6% of cases, Malassezia furfur in 13%, and 1.3% each for the filamentous fungi Aspergillus fumigatus and Mucormycosis. The primary representatives of non-albicans candidiasis were Candida parapsilosis (45.6%) and Candida krusei (21.3%). Invasive mycoses in newborns (n = 12) were caused by all types of isolated fungi except Malassezia furfur. The mortality rate among patients with invasive mycoses was 75% (n = 9). 71 cases of fungal infection were community-acquired, while 6 cases of Malassezia furfur were nosocomial.A protocol for infection prevention and control (IPC) was implemented in the clinic upon detection of fungal infection to prevent nosocomial spread. The IPC algorithm includes notification of epidemiologists and clinical pharmacologists and barrier precautions. In case of filamentous fungi, mandatory isolation of the patient in a boxed room is conducted, along with ventilation disinfection and filter replacement after patient discharge. IPC standard precautions performed upon admission of a patient with Malassezia furfur superficial mycosis were ineffective.Susceptibility testing of disinfectants and antiseptics was conducted, and the resistance of Malassezia furfur to agents used for general cleaning and disinfection of incubators was determined. Rotation of disinfectants based on fungicidal activity led to the cessation of nosocomial spread. Discussion: The analysis confirms high mortality rate of newborns with invasive mycosis (75%), thus highlighting the necessity of continuous quality epidemiological surveillance of fungal infections in the neonatal ICUs. It is worth noting that although Candida albicans is relatively widespread, our study and other epidemiological stusies describe its increasing displacement by Candida non-albicans. Conclusion: It was determined that colonization and development of invasive mycoses among newborns are most often caused by Candida sp., while the detection of filamentous fungi remains sporadic. The etiological role of Malassezia furfur requires further investigation. Disinfectants and antiseptics should be studied for their fungicidal activity.