Risk factors associated with fungal peritonitis in very low birth weight neonates with severe necrotizing enterocolitis: a case-control study

Fungal peritonitis is uncommon is infants with severe necrotizing enterocolitis with intestinal perforation. In our institution we noted a significant (P ≤ 0.01) increase in fungal peritonitis from 7% (3 of 45 cases of peritonitis) from January, 1980, to June, 1989, to 35% (8 of 23 cases of peritonitis) from July, 1989, to December, 1991. The mean birth weight of 11 infants with fungal peritonitis (946 ± 70 g) (mean ± SE) was significantly less (P = 0.008) than that of 57 infants with bacterial peritonitis (1282 ± 52 g). In a case-control study to identify risk factors associated with fungal peritonitis, 11 infants with bacterial peritonitis were matched to the 11 infants with fungal peritonitis by age at bowel perforation and birth weight. Infants with fungal compared with bacterial peritonitis had significantly longer (P < 0.05)median duration of umbilical vessel catheterization before bowel perforation, 10 vs. 3 days, respectively; median duration of antibiotic therapy before bowel perforation, 23 vs. 14 days, respectively; and median duration of intubation, 13 vs. 5 days, respectively. Other potential risk factors that were not significant in this study included duration of central venous catheterization, total parenteral nutrition, intravenous lipid administration, aminoglycoside use, dexamethasone use or methyl xanthine therapy. In summary fungal peritonitis in neonates with necrotizing enteritis was significantly related to extremely low birth weight, prolonged umbilical vessel catheterization, prolonged exposure to antibiotics and prolonged intubation.