Sir.—The article entitled "Primary Renal Candidiasis in Two Preterm Neonates" by Pappu et al,1 although covering certain important points relating to fungal disease of the newborn, fails to explore many pertinent areas. Specifically, they failed to comment on the pathogenic role of broad-spectrum antibiotics, the way in which the overall therapeutic strategy relates to the continued use of these antibiotics, and the difficulty in diagnosing systemic candidal infections.
The frequent association of broad-spectrum antibiotic treatment with infection by Candida has been observed for over 40 years. Although multiple theories have been entertained, the only logical one to survive, as discussed in multiple review articles, implicates the suppression of normal bacterial flora by these antibiotics, allowing uninhibited overgrowth by resistant organisms such as Candida.2-4
The subsequent systemic spread of these organisms from a bowel source was first addressed in 1930 by Fisher.5 Using dog models, Fisher found