Neonatal Candidiasis: Clinical Spectrum and Epidemiology at a Tertiary Care Centre, Bhopal, India

Abstract

Introduction: Neonatal candidiasis is one of the leading causes of sepsis amongst newborns admitted to newborn care unit, especially premature and Low Birth Weight (LBW) babies. It is one of the significant contributors to neonatal morbidity and mortality. Aim: To describe the spectrum and epidemiology of fungal sepsis in Neonatal Intensive Care Unit (NICU) at a tertiary care level. Materials and Methods: A longitudinal study was conducted from January 2018- December 2019 in NICU of Chirayu Medical College and Hospital, a tertiary level hospital in Bhopal, Central India. All neonates, who had positive fungal blood culture were included in the study, their demographic data was analysed (age, birth weight, predisposing factors etc.,), maternal history, their response to the antifungal treatment documented and complications. Statistical analysis was done using the Chi- square test with the help of Statistical Package for Social Sciences (SPSS) software version 2.0. Results: A total of 409 neonates admitted in the NICU during the study period, were suspected clinically to have sepsis and their blood culture was done, of which 110 samples were culture positive. Amongst the 110 neonates, 41(37.2%) were positive for fungal infection {29 showed Candida albicans, 12 Non Albicans Candida (NAC)}. Total 25 neonates were preterm (60.97%). The mean age of admission was 3.02 days, 51.2% (21/41) of the neonates had a history of respiratory distress and related symptoms at birth. There was no significant maternal history. Amongst the risk factors, lower birth weight (<2.5 kg), preterm (<34 weeks), and presence of invasive central lines were statistically associated with morbidity. Urine for candidial hyphae was positive in 12 out of 41 cases (29.27%). Incidence of candidal meningitis was seen in four neonates (13.33%). Thrombocytopenia was the most common laboratory finding amongst these cases (32/41). Among the different regimens used the combination regimen of Lipid based amphotericin B and voriconazole was associated with a better survival. Conclusion: Candida sepsis was found to be the most common cause of septicaemia in the NICU. LBW and preterm babies are especially at greater risk of candida sepsis. Candida albicans still continues to be a dominant aetiology for fungal sepsis, as compared to non candida species.