Candidoses invasives en réanimation néonatale

Les infections invasives néonatales à Candida sont en augmentation aux USA. Elles concernent respectivement 0,3 % des nouveau-nés de plus de 2500 g et jusqu’à 20 % et des nouveau-nés de moins de 1000 g aux États-Unis. Deux grandes populations de nouveau-nés sont particulièrement exposées : les prématurés et les nouveau-nés avec des pathologies digestives graves. Cinquante pour cent des nouveau-nés hospitalisés en réanimation néonatale sont colonisés à Candida à la fin de la première semaine d’hospitalisation et il existe une relation directe entre l’importance de la colonisation et le risque d’infection invasive. L’espèce la plus souvent retrouvée est C. albicans chez le nouveau-né. Ces infections représentent la troisième cause d’infections nosocomiales sur cathéter aux États-Unis. La mortalité chez le nouveau-né attribuable à cette maladie est de 20 à 50% ; la morbidité concerne d’abord le système nerveux central et les poumons. Les facteurs de risque sont connus et des actions de prévention primaire sont possibles. Le diagnostic des infections invasives néonatales à Candida est difficile et souvent retardé car la clinique est polymorphe. Le traitement préemptif ou empirique repose sur l’utilisation de l’amphotéricine B ou du fluconazole. Un traitement prophylactique des nouveau-nés de poids de naissance ≤ 1000 grammes et/ou d’âge gestationnel ≤ 27 semaines d’aménorrhée est recommandé par les Sociétés savantes américaines d’infectiologie et de pédiatrie. Une meilleure connaissance des données épidémiologiques françaises dans ce domaine améliorerait la prise en charge de cette maladie tant au niveau diagnostique que thérapeutique. Summary In the USA, the incidence of invasive candidiasis in neonates is respectively 0.3% of infants over 2500g and up to 20% of infants less than 1000g. Their incidence is increasing. Two populations of newborn infants are particularly vulnerable : the premature infants and newborn infants with severe neonatal digestive diseases. Fifty percent of infants hospitalized in NICU are colonized with Candida at the end of the first week of hospitalization ; a direct relationship exists between the importance of colonization and the invasive infection risk. C. albicans is the species most often responsible for invasive candidiasis in the newborn. These infections represent the third cause of related-catheter infection in the USA. Mortality rate in neonates linked to this disease is 20 to 50% ; morbidity primarily concerns brain and lungs. Neonatal invasive candidiasis risk factors are known and a primary prevention is possible. The diagnosis of neonatal invasive candidiasis is difficult and often delayed because of a polymorphic clinical expression. Empiric and preemptive treatment are based on the use of amphotericin B. Prophylactic treatment using fluconazole of newborns with birth weight ≤ 1000 grams and/or gestational age ≤ 27 weeks gestation is recommended by the American Academy of Paediatrics and the Infectious Diseases Society of America. A better knowledge of French epidemiological data in this area would improve both the diagnosis and therapeutic management of this disease. Références [1] L.M. Mahieu N. Van Gasse D. Wildemeersch Number of sites of perinatal Candida colonization and neutropenia are associated with nosocomial candidemia in the neonatal intensive care unit patient Pediatr Crit Care Med 11 2010 240 245 [2] D.K. Benjamin Jr. B.J. Stoll M.G. Gantz Neonatal candidiasis: epidemiology, risk factors, and clinical judgment Pediatrics 126 2010 e865 e873 [3] D.A. Kaufman Neonatal candidiasis: clinical manifestations, management and prevention strategies J Pediatr 156 2010 S53 S67 [4] C.M. Brendel Candidiasis Remington W.B. 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