Malassezia furfur Emergence and Candidemia Trends in a Neonatal Intensive Care Unit During 10 Years: The Experience of Fluconazole Prophylaxis in a Single Hospital.
I-Ting Chen, Chih-Cheng Chen, Hsin-Chun Huang and 1 others
PMID 31306235WHAT IT FOUND
In a NICU using fluconazole prophylaxis, no candidemia cases were reported after 2014, while Malassezia furfur colonization emerged in preterm infants with catheters and lipid infusions.
All 20 Malassezia cases survived.
Key findings
01No candidemia cases were reported in the NICU after 2014, while Malassezia furfur emerged.
02Between 2014 and 2016, 19 catheter-related Malassezia furfur colonizations and 1 fungemia occurred, and all 20 neonates survived.
03The 19 neonates with positive catheter tip cultures and negative blood cultures were initially managed with catheter removal, and none had fungemia or clinical manifestations of Malassezia infection.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 8 candidemia cases and 20 Malassezia cases were reported from one 30-bed NICU, so the findings are too few to guide unit policy. The study looked backward at records, so selection and information bias could have affected which cases were included and how they were classified. The authors state the small case number and short investigation period prevented further analysis of factors contributing to Malassezia colonization, including antibiotic resistance. The authors state long-term outcomes of prophylactic fluconazole are limited because of short follow-up and small case numbers. Because the study was descriptive, the shift in fungal species cannot be proven to be caused by fluconazole.
The easy way to misread this
Do not read this as proof that fluconazole prophylaxis caused Malassezia furfur colonization or should be stopped. The study is retrospective, has only 8 candidemia cases and 20 Malassezia cases from one NICU, and all infants had multiple exposures, including prematurity, central catheters, lipid infusions, broad-spectrum antibiotics, and most received fluconazole.