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

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 nonalbicans 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 withpositive blood cultures were enrolled. Incidenceandrisk factors of albicansandnon-albicans candidemia were evaluated. The Etest 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 managementthat should encompass disciplined infection control practices and a restrictive policy for antibiotic and antifungal prophylaxis.