Candida Infection: Prevalence, Associated Risk Factors, and Outcomes from a Tertiary Care Centre NICU/PICU in South India – A Retrospective Study

Background: Advanced healthcare facilities have improved the survival of preterm babies and critically ill or immuno-compromised children. However, they have simultaneously increased the incidence of opportunistic infections like candidiasis. Materials and methods: This is a 3-year retrospective descriptive study from the paediatric intensive care unit (PICU) and neonatal intensive care unit (NICU) of a tertiary care hospital in South India. The authors retrieved data from culture-proven candidiasis in blood, urine, and other fluids from January 2019–December 2021 to identify causative species, antibiotic sensitivity patterns, associated risk factors, and patient outcomes. Results: Out of 1,843 admissions, 276 patients had culture-proven infections; among them, 22 (1.12%) were Candida. The incidence of Candida infection was 0.7% and 1.4% in the NICU and PICU, respectively. Out of 22 candidiasis cases, 77.2% were from the PICU and 22.7% from the NICU. Candida albicans and Candida tropicalis were the most common isolates in the NICU and PICU, respectively, and they were sensitive to fluconazole, other azoles, and echinocandins. Predisposing risk factors included the presence of invasive lines (77.3%), prior antibiotic exposure (95%), and surgical intervention (10%). A total of 54.5% of cases had bacterial co-infection during management. Overall mortality was 22.7%, with 20% and 23.5% cases from the NICU and PICU, respectively. All of these patients had multiple comorbidities, and some had serious bacterial co-infections. Conclusion: C. albicans and C. tropicalis are the commonest species responsible for invasive Candida infections, which are highly sensitive to fluconazole. These infections are almost always associated with risk factors, which is why high suspicion and early management are key to achieving a better outcome in such cases.