Clinico-epidemiological profile, risk factors, and prognosis of neonatal candidemia due to Candida parapsilosis: An emerging threat to neonates

Abstract

Background: Candida species are the third most common blood culture isolates recovered from cases of late onset sepsis in neonatal intensive care unit (NICU). Candida parapsilosis is probably, the species that have had the largest increase in incidence since 1990, becoming the predominant agent of candidemia in certain centers. We evaluated the prevalence of neonatal candidemia due to C . parapsilosis and the main clinico-epidemiological aspects of this disease in neonates. Materials and Methods: This retrospective observational study was conducted for a period of 18 months at our rural tertiary care and referral center. Hospital records of the neonates with candidemia due to C . parapsilosis were reviewed. The Candida species isolated were identified as per standard mycological techniques. Results: Of total 163 neonates diagnosed of candidemia, 43 (26.38%) corresponded to C . parapsilosis . Failure to thrive (74.42%), abdominal distention (67.44%), and feed intolerance (65.12%) were the most common clinical presentations seen. Among the risk factors observed broad spectrum antibiotics (81.40%), total parenteral nutrition (79.07%) and indwelling catheters (79.07%) were the most common followed by prematurity (72.09%) and low birth weight (65.12%). Early mortality accounted for 20.93%, whereas late mortality accounted for 11.63% of the cases. Conclusion: Progressive shift of C . albicans to non- albicans Candida species, particularly C . parapsilosis substantiates the need of continuous monitoring of laboratory data. C . parapsilosis is an emerging fungal pathogen and the major threat for neonates in NICU. Local epidemiological knowledge is critical in terms of prevention and management of invasive Candida infections.