Fungal Sepsis in Tertiary NICUs: Risk Factors and Susceptibility Pattern of Candida Species to Antifungals

Ashwini Ananthaiah, Mahesh Maralihalli, Vijay Kulkarni

Abstract

Aim: To review the risk factors of neonatal fungal sepsis and study the susceptibility pattern of Candida species to various antifungal drugs

Materials and Methods: This prospective study was conducted in the NICU of Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital (Dharwad, Karnataka, India). Neonates in the NICU whose blood cultures tested positive for Candida species were included in the study. Their blood samples were cultured and assayed for identification and isolation of the causative Candida species. The susceptibility pattern of the isolated Candida species to various antifungal drugs was studied. The appropriate antifungal therapy was then administered.

Results: A total of 107 blood cultures were positive for Candida species. Of these, there were 53 cases of candidal sepsis. A total of 71 blood cultures had the following Candida species—Candida krusei 55 (77%), Candida albicans 7 (9.8%), Candida tropicalis 3 (4.2%), Candida lipolytica 2 (2.8%), Candida rugosa 2 (2.8%), Candida glabrata 2 (2.8%).

Conclusions: Candidal sepsis was more common among preterm and low-birth-weight neonates. Use of broadspectrum antibiotics, a prolonged NICU stay, total parenteral nutrition, and umbilical vein catheterization were the significant risk factors of fungal sepsis. The Candida species showed 100% sensitivity to caspofungin, micafungin, and voriconazole; 49.5% sensitivity to amphotericin B; 23.8% to fluconazole; and 8.4% to flucytosine.

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