Neonatal invasive candidiasis in low- and middle-income countries: Data from the NeoOBS study

Abstract

Neonatal invasive candidiasis (NIC) has significant morbidity and mortality. Reports have shown a different profile of those neonates affected with NIC and of fluconazole resistant Candida spp. isolates in low-and-middle-income -countries (LMICs) compared to high-income-countries (HIC). We describe the epidemiology, Candida spp. distribution, treatment and outcomes of neonates with NIC from LMICs enrolled in a global, prospective, longitudinal, observational cohort study (NeoOBS) of hospitalised infants < 60 days postnatal age with sepsis (August 2018-February 2021). 127 neonates from 14 hospitals in 8 countries with Candida spp. isolated from blood culture were included. Median gestational age of affected neonates was 30 weeks (IQR: 28-34) and median birth weight was 1270 g (IQR: 990–1692). Only a minority had high risk criteria, such as being born < 28 weeks, 19% (24/127), or birth weight < 1000 g, 27% (34/127). The most common Candida species were C. albicans (n = 45, 35%), C. parapsilosis (n = 38, 30%) and Candida auris (n = 18, 14%). The majority of C. albicans isolates were fluconazole susceptible, whereas 59% of C. parapsilosis isolates were fluconazole resistant. Amphotericin B was the most common antifungal used [74% (78/105)], followed by fluconazole [22% (23/105)]. Death by day 28 post-enrolment was 22% (28/127). To our knowledge, this is the largest multi-country cohort of NIC in LMICs. Most of the neonates would not have been considered at high risk for NIC in HICs. A substantial proportion of isolates was resistant to first choice fluconazole. Understanding the burden of NIC in LMIC is essential to guide future research and treatment guidelines.

Candida auris Infection, a Rapidly Emerging Threat in the Neonatal Intensive Care Units: A Systematic Review

“…Wound and soft tissue infections, osteomyelitis, central nervous system infections, and generalized infections in immunosuppressed patients have been described in the international literature [ 60 ]. According to our systematic review, we located 24 publications [ 23 , 24 , 25 , 32 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ] from 2013 until today, in which 476 cases of C. auris infections are reported. Unfortunately, there was a lot of information missing among the retrieved studies.…”

Safety and efficacy of whole-body chlorhexidine gluconate cleansing with or without emollient in hospitalised neonates (NeoCHG): a multicentre, randomised, open-label, factorial pilot trial

“…This may require further consideration since neonatal invasive candidiasis has been shown to be an important cause of neonatal sepsis cases in LMICs and associated with a >20% mortality. 25 …”

Antibiotic Analgesic-Sedative and Antiseizure Medications Frequently Used in Critically Ill Neonates: A Narrative Review

“…The incidence of neonatal invasive candidiasis has been reduced in the last decade in high-income countries, but the burden of fungal disease is still significant in high-risk neonates, with severe neurodevelopmental sequelae and a high case-fatality rate of 20% up to 50% in extremely low birth weight infants [53]. Meanwhile, the majority of neonates with invasive candidiasis included in the NeoOBS invasive candidiasis sub-study (data from low-middle income countries) had gestational age > 28 weeks (81%) and birth weight > 1000 g (73%) [53][54][55][56]. Differences between NICU level of care, underlying comorbidities, feeding strategies, antifungal prophylaxis use, antibiotic stewardship, and infection prevention and control bundle measures may explain the great variance of the epidemiology of invasive candidiasis in different geographical regions [53,[56][57][58][59][60].…”

“…Meanwhile, the majority of neonates with invasive candidiasis included in the NeoOBS invasive candidiasis sub-study (data from low-middle income countries) had gestational age > 28 weeks (81%) and birth weight > 1000 g (73%) [53][54][55][56]. Differences between NICU level of care, underlying comorbidities, feeding strategies, antifungal prophylaxis use, antibiotic stewardship, and infection prevention and control bundle measures may explain the great variance of the epidemiology of invasive candidiasis in different geographical regions [53,[56][57][58][59][60]. While Candida (C.) albicans remains the leading cause, followed by C. parapsilosis, C. tropicalis, C. glabrata and C. krusei, whereas C. auris has emerged as the third most commonly encountered species causing neonatal invasive candidiasis in low -middle income countries [51,56,59,61].…”

“…Differences between NICU level of care, underlying comorbidities, feeding strategies, antifungal prophylaxis use, antibiotic stewardship, and infection prevention and control bundle measures may explain the great variance of the epidemiology of invasive candidiasis in different geographical regions [53,[56][57][58][59][60]. While Candida (C.) albicans remains the leading cause, followed by C. parapsilosis, C. tropicalis, C. glabrata and C. krusei, whereas C. auris has emerged as the third most commonly encountered species causing neonatal invasive candidiasis in low -middle income countries [51,56,59,61]. In a recent European 12-week modified point prevalence study (mPPS) which included 26 NICUs, 17 hospitals, and eight countries, the median percentage of neonates receiving antifungal agents per mPPS week across all NICU Level III was 9.6% (range 7.5-11.4%).…”