Colonization

The fungal colonization rate for low birth weight infants (<1500 g) ranges from 19 to 47% in the first 24 hours of life (3,5,8). In one study, the most common site of early colonization (i.e., at birth or first 24 hours of life) was the GI tract, as demonstrated by positive rectal fungal cultures. At birth, 86% had rectal colonization, followed by 60% with tracheal colonization and 57% with oropharyngeal colonization (5). The endotra-cheal acquisition at birth represents aspiration of the yeast during labor and delivery. Oropharyngeal acquisition at birth was not as frequent as rectal acquisition. At 1-2 weeks of age, the detection of yeast in the rectum and oropharynx was less likely. Late colonization was more often detected in the groin cultures. By 2 weeks of age, 64-85% of low birth weight neonates were colonized with Candida in the groin sites.

Colonization rates were higher for C. parapsilosis (56%) than C. albicans (44%) in one study in which surface cultures were obtained between the first and second weeks, third and fourth weeks, and fifth and sixth weeks of age (9). In several studies, C. parapsilosis colonization occurred after the first or second week of life and could not be accounted for by a maternal reservoir (3,4,9). However, this was not true in one study in which C. parapsilosis colonization occurred early in the first day or week of life

(5). C. tropicalis, however, tends to appear as a colonizer later, after the first 2 weeks of life, and therefore tends to appear as a pathogen in late-onset disease (>7 days of age).

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