Candida Species Causing Neonatal Septicaemia - Experience in a Tertiary Care Centre

BACKGROUND Candida species is one of the most common causes of bloodstream infections among neonates and accounts for 9-13% of such infections. Non-albicans Candida have emerged as important opportunistic pathogens, notably C. tropicalis, C. glabrata, C. parapsilosis and C. krusei. With the introduction of antifungal agents, the causes of Candida infections shifted from an almost complete dominance of Candida albicans to the common involvement of Candida glabrata and other non-albicans Candida species. METHODS This prospective, microbiological observational study was conducted in a tertiary care hospital for one and a half years from July 2016 to December 2017. Blood samples of neonates collected into Bactec Peds Plus/F Culture vials of an automated blood culture system (Bactec 9120, Becton Dikinson, USA) from clinically suspected cases of neonatal septicaemia were subjected to culture. Detailed clinical history such as presence of respiratory distress, abdominal distension, lethargy, feed intolerance, failure to thrive, poor perfusion, history of convulsions, duration of NICU stay and antibiotic use was taken from the medical records. The Candida species isolated were identified using standard mycological techniques. RESULTS Out of the total 250 clinically suspected cases of neonatal septicaemia, fungal growth was positive in 30 (12%) cases. Candida albicans accounted for 10% and non albicans Candida accounted for 90% of the fungal isolates. Candida glabrata (73.33%) was the commonest species followed by Candida tropicalis (16.67%) and Candida albicans (10%). Failure to thrive (60%), lethargy (50%) and respiratory distress (30%) were the most common clinical presentations seen, followed by feed intolerance (26.67%), abdominal distension (13.33%) and fever (10%). Among the risk factors observed for neonatal candidemia, low birth weight (76.67%) and prematurity (73.33%) were commonest followed by broad spectrum antibiotic use (66.67%), total parenteral nutrition (53.3%), ventilator support (36.67%) and indwelling catheters (26.67%). CONCLUSIONS Non-albicans Candida has emerged as an important pathogen causing neonatal septicaemia. Fungal sepsis is more common among preterm, low birth weight infants, those with prolonged antibiotic use and those on total parenteral nutrition. Candida glabrata caused the highest number of cases of fungal septicaemia.