Epidemiology and Risk Factors Associated With Rise of Non Albicans Candidemia at Nicu of a Tertiary Care Institute

Abstract

Background:Candidemia continue to be a critical challenge in neonatal intensive care units worldwide despite remarkable progress in diagnostic and therapeutic approaches. Over past few years, there has been a progressive mycological shift fromCandidaalbicans to non albicans Candida species. Objectives: To identify the epidemiology and riskfactors of neonatal candidemia in NICU of a tertiary care hospital. Material Methods:Blood samples of neonates with provisional diagnosis of sepsis, routinely received in the Department of Microbiology of our institution were screened to highlight pattern of candida species recovered and their antifungal sensitivity. Possible risk factors associated were also analyzed. Results: Candidemia was proven in 4.33%(N=52) and bacteremia in 10.50%(N=126)] among twelve hundred samples received from NICU. Clinically significant isolates(N=178), demonstrated41%(N=73) Gram positive isolates,29.8% (N=53) Gram negative isolates and 29.22%(N=52) non albicans Candida [Candida krusei(N=38, 21.34%); Candida parapsilosis (N=6, 3.37%); Candida tropicalis(N=3, 1.68%); Candida pelliculosa(N=2, 1.1%); Candida lipolytica(N=2, 1.12%); Candida dublinansis, (N=1, 0.56%), with preponderance towards late neonatal period(p value = 0.045*). 80-100% NAC isolates were sensitive to amphotericin B except for C. pelliculosa. Ckruseiwas100% resistant to fluconazole. Preterm, low birth weight neonates, using antibiotics for longer duration, total parenteral nutrition and mechanical ventilation were significant risk factorsfor candidemia. Conclusion:The advent of non albicans Candida species merits attention as they are highly resistant to most of the azoles. Therefore, speciation of Candida in septicemia is essential to institute appropriate antifungal therapy.