A Case–Control Study of Candidaemia in Very Low Birthweight Infants in a Tertiary Hospital in Johannesburg

Abstract

Abstract Background: Candidaemia is a significant cause of morbidity and mortality in infants. The mortality rate ranges between 21% and 76%. Non-albicans Candida (NAC) species are increasing in incidence as well as resistance to azoles. Very low birthweight (VLBW) infants have numerous risk factors which predispose them as a group to invasive candidaemia. Methods: A retrospective case–control study of candidaemia in VLBW infants admitted to the neonatal unit at Charlotte Maxeke Johannesburg Hospital between 1 January 2015 and 31 December 2017 was undertaken. Clinical and demographic characteristics of VLBW infants who developed candidaemia, commonest Candida species, antifungal susceptibility profiles and outcomes (death) were identified. A total of 71 infants with confirmed positive blood cultures for candidaemia from the National Health Laboratory Services database were selected, and each case was allocated 3 controls; the final sample comprised 284 infants. Results: Bacterial sepsis, chronic lung disease, necrotising enterocolitis (NEC) and NEC surgery, other surgery, anaemia and ventilation, all showed a strong association with development of candidaemia in the infants. The most common isolate was Candida parapsilosis (59.1%), followed by Candida albicans (30.9%). The cases of candidaemia overall and NAC isolates increased over the study years. Resistance to azoles by NAC was demonstrated. Mortality was 31.2% and 28.2% in controls and cases, respectively. The difference in death between the two groups was not statistically significant. Conclusions: The study demonstrated an increasing rate of candidaemia, predominance of NAC isolates and increased resistance to azoles. Stricter infection control measures and medical intervention strategies should be implemented.