Profile and Assessment of Potential Risk Factors of Neonatal Candidemia Cases in a Tertiary-care Hospital in North India

Introduction Candida blood stream infections (BSIs) are a major contributing factor to neonatal sepsis and sepsis-related morbidities. Despite advances in newborn care, there remains a considerable morbidity, a trend towards neonatal candidemia, and occasional cases of antifungal resistance. Aim Our study aimed to identify the prevalent Candida species, antifungal susceptibility (AFS) patterns, and to ascertain risk factors associated with candida BSIs in neonates. Materials and Methods This was an eighteen-month retrospective study of candidemia in neonates. Positive aerobic BactT-Alert blood cultures having yeast were speciated (HiMedia Chrom-Agar and Vitek2®). AFS of isolates was performed using VITEK2® and disc diffusion. Results 303 (11.1%) out of 2748 positive blood cultures revealed Candida species, from which 84 (27.7%) were confirmed as newborn (0 to 28 days) BSI cases. Candida tropicalis (29.8%) was the most common isolate, followed by Candida albicans (26.2%) and C. glabrata (25%). AFS of these isolates revealed overall resistance of amphotericin B as 2.4% and of fluconazole as 13.1%. 60 isolates tested by Vitek 2 were sensitive to voriconazole; there was 5% caspofungin, 1.7% micafungin, and 1.7% flucytosine resistance. Risk factor assessment included NICU admission (60.7%), broad-spectrum antibiotic usage (71.4%), low birth weight (65.5%), prematurity (65.5%,), ventilator support (44%) and mortality (23.8%). Conclusion The rise in resistance and neonatal candidemia emphasises the necessity of reevaluating the application of stringent infection control methods, suitable prophylactic antifungals, and a limited antibiotic-use strategy, among other preventative, as well as therapeutic approaches.