Epidemiology, risk factors and outcomes associated with candidaemia in very low birth weight infants at a tertiary South African Hospital over a 7-year period (2013–2019)

Abstract

IntroductionCandidaemia is a significant problem in neonatal units and is associated with high morbidity, including long-term neurodevelopmental impairment in survivors, and high mortality of very low birth weight infants (VLBWI). MethodA retrospective cohort study amongst VLBWI admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa, from 1 January 2013 to 31 December 2019. All VLBWI were born at the hospital or transferred to the neonatal unit from birth to day 28 of life with blood culture confirmed candidaemia. ResultsDuring the study period, 3414 VLBWI were admitted to the unit. Of these, 5.12% (n = 176) developed culture confirmed candidaemia. The incidence was 5.1 per 1000 admissions. The most common species, which persisted throughout the study period, was Candida parapsilosis, followed by Candida albicans. C. parapsilosis peaked in 2018 while C. albicans peaked in 2015. Emergence of C. auris occurred in 2019. Important risk factors associated with the development of candidaemia included necrotizing enterocolitis (p < 0.001, OR 4.63 [3.29–6.54]), surgery (p < 0.001 OR 7.02 [4.48–11.12]), conventional ventilation (p < 0.001, OR 6.23 [4.48–8.68]), patent ductus arteriosus (p < 0.001, OR 3.81 [2.67–5.44]), intraventricular haemorrhage (p < 0.001, OR 3.32 [2.99–5.44]) and prolonged hospital stay (p < 0.001). Mortality was not statistically different (p = 0.80 OR 0.95[0.68–1.31]) between the two groups. ConclusionThere is a high incidence of candidaemia in the neonatal unit. Several modifiable risk factors including improved antifungal stewardship and prevention of candidaemia with oral or systemic antifungal prophylaxis may decrease the incidence of candidaemia, and associated morbidity.