Bloodstream infection in a neonatal intensive care unit: Epidemiology, Antifungal susceptibility and new drug delivered strategies.

Bloodstream infection in neonates is a complicated disease and presents a major challenge both in diagnosis and in therapeutic intervention. The focus of the present study was to investigate the incidence, the species distribution and the risk factors associated with mortality of bloodstream infections in a neonatal intensive care unit (NICU) and evaluating the antifungal susceptibility of traditional antifungal drugs and three nanoparticle-based drug delivery systems based on nanoparticles. A total of 458 patients were evaluated, and 9.38 % were confirmed to have bloodstream infections through laboratory tests. The death rate was higher among neonates with fungal infections (66.7 %) compared to those with bacterial infections (5.4 %). Severe health conditions contributed to the increased mortality rate, especially gestational age <28 weeks and weight <1.000 g. Coagulase-negative staphylococci were the major pathogens (64.9 %) considering cases of neonatal sepsis. Candida albicans was the predominant causative agent among neonates with fungemia, although non-albicans species led to the highest mortality rates. In vitro antifungal activity evidenced resistance of C. tropicalis to fluconazole and voriconazole. Three nanoparticles were evaluated: chitosan-coated PLGA containing Amphotericin B, zein containing voriconazole and PLA containing voriconazole, and results were considered promising. The present findings demonstrate the importance of constant epidemiological surveillance in a NICU and the severity of fungal infection in neonates. The results suggest the potential of nanotechnology as an alternative in the treatment of fungal infection.