Changing pattern of Candida species in a neonatal intensive care unit

Abstract

S ir : We were interested in an article which was posted 22 July 2010 ahead of print on the early on-line service of Medical Mycology [1]. While Yapar and colleagues noted in their report that Candida albicans was the most commonly recovered Candida species in 83 blood cultures, nonC. albicans Candida species, e.g., Candida tropicalis , Candida parapsilosis , Candida glabrata , were isolated in increasing frequency from adult patients. Collectively, the nonC. albicans Candida species were found to be associated with 43% of the cases of candidaemia in their study. The predictors of candidaemia included the presence of a urethral catheter, prior use of antibiotics, red blood cell transfusions and parenteral nutrition. Total parenteral nutrition was an independent risk factor for candidemia caused by C. albicans and nonC. albicans Candida species . We performed a retrospective, single centre study in the neonatal intensive care unit (NICU) of Ankara Sami Ulus Maternity, Childrens ’ Education and Research Hospital between January 2005 and December 2009 to assess the rate of invasive candidiasis among low birth weight premature newborns. During this period, 24 neonates with a mean gestational age of 30 weeks (range 24 – 36 weeks) and a mean birth weight of 1,455 g (range 780 – 2,470g) developed invasive candidiaemia, i.e., an overall incidence of 1.4% but with an increasing trend over the study period. All infections were acquired nosocomially and developed within a mean of 17.5 (range 6 – 53) days after birth. The four most frequent causative Candida species were C. parapsilosis (32%), C. pellucilosa (32%), C. albicans (22%) and C. glabrata (8%), that is nonC. albicans Candida species were the etiologic agents of 72% of the candidaemia cases in our series. C. albicans was the predominant species recovered between 2005 and 2008, whereas, nonC. albicans Candida species, particularly C. parapsilosis , were the most frequent species during the period 2008 – 2009. Risk factors for candidemia were total parenteral nutrition (87.5%), mechanical ventilation (62.5%), antimicrobial therapy (37.5%), central venous catheter insertion (29.2) and necrotizing enterocolitis (29.2%). The overall mortality due to candidemia in our patients was 4.2% (1 of 24 cases, Table 1).