Clinical spectrum and outcomes of neonatal candidiasis in a tertiary care hospital in Karachi, Pakistan

Introduction: Candidal infections are a serious problem in neonatal intensive care units, increasing morbidity and mortality in low birth weight infants in addition to escalating health-care costs. Studies exploring the epidemiology of candidiasis in developing country hospitals are rare. This retrospective case-control study aimed to evaluate epidemiology and risk factors associated with candidiasis in a neonatal intensive care unit in Karachi, Pakistan. Methodology: Cases (neonates (age < 28days, (n = 45) with NICU discharge diagnosis of candidal sepsis or candidemia between January 1996 and December 2006 were matched with controls (newborns with discharge diagnoses other than the above during the same study period) for gender, gestational age, and admission within 72 hours of admission of an index case. Risk factors were identified and clinical course and outcomes (discharge disposition) described. P-value and match-adjusted odds ratios were calculated. Results: A frequency of 0.9% candidemia was documented in the NICU. The incidence was highest (46%) in VLBW (< 1500gm). C. albicans was the leading causative organism (55%), and neonatal risk factors identified were mechanical ventilation (> 7 days), positive bacterial culture, and duration of hospitalization of > 7 days. Conclusions: Prolonged ventilation, positive bacterial blood culture, and prolonged duration of NICU stay were the major risk factors associated with newborn fungal sepsis in our center. Presence of antenatal care was a significant protective factor in our subset of neonatal population.