Candidemia in the Neonatal Intensive Care Unit: Insights on Epidemiology and Antifungal Drug Susceptibility Patterns

Abstract

Background: Being the culprit in 9% - 13% of neonatal bloodstream infections (BSIs), candidemia has been escalating to worrisome levels in the past few decades. While C. albicans has traditionally been the most common isolate, non-albicans Candida spp. are currently gaining a foothold. Objectives: We endeavored to investigate the epidemiological features of neonatal candidemia with special emphasis on non-albicans candidemia. Hence, we evaluated the incidence, risk factors, antifungal susceptibility, and case fatality rate of candidemia patients in the NICU. Methods: Blood samples were collected from 1296 neonates admitted to the NICU of a tertiary care hospital. Then, only neonates with positive blood cultures were enrolled. Incidence and risk factors of albicans and non-albicans candidemia were evaluated. The E-test was employed to determine the minimum inhibitory concentrations of fluconazole, itraconazole, voriconazole, amphotericin B, and caspofungin. Results: Out of 214 neonates with BSI, candidemia afflicted 32 neonates (15%). The predominant isolate was C. tropicalis (43.8%), followed by C. albicans (25%). Both antibiotic use and antifungal prophylaxis were contributing factors (P values of 0.02 and < 0.01, respectively). Susceptibility testing revealed that 87.5% of the retrieved Candida isolates were sensitive to amphotericin B, 81.25% to fluconazole, 75% to voriconazole, and 62.5% to itraconazole while 48.75% were sensitive to caspofungin. Conclusions: Neonatal candidemia often carries an ominous prognosis. The worldwide progressive shift towards non-albicans candidemia necessitates regular surveillance and monitoring of laboratory data. An epidemiological knowledge is critical in terms of preemptive management that should encompass disciplined infection control practices and a restrictive policy for antibiotic and antifungal prophylaxis.