Incidence of invasive candidal infection in very low birth weight neonates over a period of 5-year: A single institutional study

Abstract

Background: Fungal infection is one of the important causes of bloodstream infection in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. Objective: To find out the incidence, mortality rate, and clinical spectrum of infants with invasive candidal infection (ICI) among VLBW infants. Materials and Methods: A retrospective descriptive study was conducted over a period of 5-year at a tertiary care hospital. VLBW infants admitted within 24 h of birth were included. The clinical characteristics and the outcome of the infants who developed fungal infection were studied. The end point was either discharge from the unit or death of the infants who developed fungal sepsis. Results: During the study period, there were a total of 641 VLBW infants admitted and 18 neonates had invasive fungal infections (ICI), which accounted to an incidence of 2.8%. The mean birth weight was 1010±289 g, and the mean gestational age (GA) was 28.6±2.93 weeks. End organ involvement was found in 9 (50%) infants with the eye being the most commonly involved organ (39%) followed by renal involvement (22%). Stratified analysis revealed that lower GA and lower birth weight were associated with higher incidence of ICI (p<0.01). Out of 18 isolates that were identified, Candida albicans was the most common organism isolated in 13 (72%) infants. More than ¼ of the cultures (28%) isolated were non-albicans Candida species. The mortality rate among infants with ICI was 11% (2/18). The two infants who died had septicemia caused by C. albicans and multiple (renal and eye) end organ involvement. All-cause mortality in the study group was also 11% (73/641). Conclusion: The incidence of ICI without systemic antifungal prophylaxis was 2.8% and 5.3% in VLBW and ELBW infants, respectively. C. albicans was more common, but the emergence of Candida non-albicans is seen as a growing threat with some of them displaying resistance to azole group of antifungals.