Healthcare-associated Candida infections in neonates: A clinical perspective on risk and outcome

ObjectiveHealthcare-associated infections (HAIs) remain a major cause of morbidity and mortality in neonatal intensive care units (NICUs), particularly in preterm and low birth weight infants. Candida species are among the most frequently isolated fungal pathogens in this vulnerable population.Study DesignThis retrospective study was conducted in a tertiary NICU in Turkey between January 1, 2015, and December 31, 2023. Daily active surveillance was used to detect HAIs. Neonates with Candida-positive blood cultures were identified. Demographic characteristics, clinical risk factors, laboratory findings, and treatment outcomes were analyzed.ResultsAmong 9065 neonates admitted to the NICU during the 9-year study period, 26 (0.28%) developed Candida bloodstream infections. The majority of affected infants were premature (84.6%) and had a birth weight ≤2500 g (80%), with 30.8% weighing <1000 g. Predisposing risk factors included: central venous catheter use (92.3%), total parenteral nutrition (96.2%), and exposure to broad-spectrum antibiotics (88.4%). The most frequently isolated species were <i>Candida parapsilosis</i> (46.2%) and <i>Candida albicans</i> (42.3%), while fluconazole resistance was detected in 15.4% of isolates. The overall mortality rate was 38.5%. The median hospital stay was 14.5 days.Conclusions<i>Candida bloodstream</i> infections are a serious complication in NICUs, particularly among extremely low birth weight and premature infants. Invasive procedures and parenteral nutrition remain major risk factors. The observed high mortality rate and resistance patterns underscore the need for enhanced infection control measures and antifungal stewardship programs in NICUs.