ABSTRACT

Introduction: Candida blood stream infections (BSIs) are a major contributing factor to neonatal sepsis and sepsis-related morbidities. Despite advances in newborn care, there remains a considerable morbidity, a trend towards neonatal candidemia, and occasional cases of antifungal resistance. 

Aim: Our study aimed to identify the prevalent Candida species, antifungal susceptibility (AFS) patterns, and to ascertain risk factors associated with candida BSIs in neonates. 

Materials and Methods: This was an eighteen-month retrospective study of candidemia in neonates. Positive aerobic BactT-Alert blood cultures having yeast were speciated (HiMedia Chrom-Agar and Vitek2®). AFS of isolates was performed using VITEK2® and disc diffusion. 

Results: 303 (11.1%) out of 2748 positive blood cultures revealed Candida species, from which 84 (27.7%) were confirmed as newborn (0 to 28 days) BSI cases. Candida tropicalis (29.8%) was the most common isolate, followed by Candida albicans (26.2%) and C. glabrata (25%). AFS of these isolates revealed overall resistance to amphotericin B of 2.4% and to fluconazole of 13.1%. 60 isolates tested by Vitek 2 were sensitive to voriconazole; there was 5% caspofungin, 1.7% micafungin, and 1.7% flucytosine resistance. Risk factor assessment included NICU admission (60.7%), broad-spectrum antibiotic usage (71.4%), low birth weight (65.5%), prematurity (65.5%), ventilator support (44%) and mortality (23.8%). 
Conclusion: The rise in resistance and neonatal candidemia emphasises the necessity of reevaluating the application of stringent infection control methods, suitable prophylactic antifungals, and a limited antibiotic-use strategy, among other preventative, as well as therapeutic approaches.