Clinical and microbiological profile of fungal sepsis in neonates: a retrospective observational study in an out-born unit

Abstract

Background: Infections due to non-Candida species though uncommon is emerging as an important cause of neonatal sepsis in neonatal intensive care unit (NICUs). The aim of this study was to determine the etiology, clinical profile, outcome and predictors of mortality in neonates with fungal sepsis.Methods: Neonates with the diagnosis of blood culture proven fungal sepsis from January 2018 to December 2019 were analysed. Relevant data was collected in a proforma from case records which included demographic information, clinical symptoms and signs, investigations, treatment and outcome. Data was analysed using IBM SPSS 25 software.Results: During the study period, 618 (13.8%) babies out of the 4461 admitted developed culture positive sepsis. Culture positive fungal sepsis were 66 (10.6%) out of total sepsis. Candida non albicans constituted 60 (90.9%) and Candida albicans was six (9.1%). The most common non-albicans species was Candida parapsilosis (25.8%). Lethargy, respiratory distress, hypothermia and apnea were common symptoms. Elevated C-reactive protein and thrombocytopenia were common laboratory findings. The mortality rate was 59.1 percentage. Delayed initiation of antifungal treatment, need for inotropes and mechanical ventilation were significant factors associated with mortality.Conclusions: Candida non-albicans was the predominant organism causing fungal sepsis. Fungal sepsis over all was associated with high mortality. Need for inotropes, mechanical ventilation and delay in initiating antifungal treatment were the significant factors associated with mortality.