585 Changing trends of candida sepsis and its impact on neonates admitted in nicu: a prospective study from a tertiary centre in India

Abstract

<h3>Aims</h3> This study is aimed to determine the prevalence, speciation, antifungal susceptibility pattern, clinical profile of affected neonates, end-organ involvement and outcome of neonates with candida sepsis. <h3>Methods</h3> King George’s Medical University is a tertiary care referral centre in city of Lucknow in north India. A total 1356 neonates were admitted during 19 months period, sepsis was suspected in 596 neonates. Neonates in whom candida species grew in any one of the blood, CSF, or urine samples, were enrolled (n=62). Speciation was done using MALDI TOF and germ tube testing method. Data was analysed using SPSS version 26. <h3>Results</h3> Prevalence of candida sepsis was 4.57% of all NICU admissions. 85.9% of the isolates were non-albicans candida (NAC) and 14.1% isolates were <i>C. albicans</i> (figure 2). <i>C.tropicalis</i> (23.4%) was the most common species. <i>Candida glabrata had</i> 100% resistance to fluconazole. <i>Candida auris</i> was isolated from 4.7% neonates and had 66.6% resistance to fluconazole, voriconazole, amphotericin B. Resistance to fluconazole was seen in 37.5% isolates, 7.8% to voriconazole, 4.7% to amphotericin B, no resistance was seen against caspofungin (figure 1). Important clinical features were lethargy (75.8%), tachypnea (59.7%), decreased cry (35.5%), convulsion (41.9%), metabolic acidosis (67.7%), increased FiO2 requirement (46.8%), vomiting (46.8%), feed intolerance (66.1%), nasal flaring (50%), positive sepsis screen (100%), LOS (75.8%) and prior antibiotics ≥ 5 days (79%), concurrent blood culture-proven sepsis (27.4%). Three clinical features, namely metabolic acidosis, increased FiO2 requirement and feed intolerance were significantly associated with NAC infection, with Odd’s ratio of 5.5, 8.9, and 5.07 respectively. Meningitis occurred in 12.9%, ventriculitis in 1.6%, UTI in 22.6%, renal fungal balls in 14.5%, endophthalmitis in 3.2%, pneumonia in 19.3%, endocarditis in 3.2%. Out of 62 neonates, 69.3% were discharged. The mortality was 14.5%. Crude mortality attributable to candidiasis (neonates dying within 72 hours of diagnosis of candidiasis) was 11.3%. 14.5% neonates expired of which 33.3% had multiple end-organ involvement and 22.2% had <i>C. auris</i> infection. <h3>Conclusion</h3> With advancing technology, critically sick neonates are surviving more. Candida sepsis is assuming an important role in nosocomial infections in neonates and is associated with high mortality and morbidity. Over time NAC species have gained more importance as reflected by high NAC prevalence, which makes it even more important to prevent candida sepsis in neonate as NAC species are more resistant to common antifungal agents and some of them are associated with increased morbidity and high mortality.