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Neonatal systemic candidiasis in a tertiary care centre
1Department of Microbiology Medical College Mumbai-400012, India.
Abstract:
The purpose of this study was to identify infections causing Candida spp. and to examine their susceptibility to antifungal drugs. The study examined 30 isolates of Candida spp. grown from blood culture samples of neonates. Clinical histories revealed that all 30 infants had received systemic broad-spectrum antibiotic therapy, 27/30 were low birth weight, 21/30 suffered from respiratory distress syndrome and 23/30 were preterm. The three species of Candida isolated were Candida albicans (16/30, 53.3%), C. tropicalis (7/30,23.3%), and C. krusei (7/30, 23.3%). Antifungal susceptibility tests against fluconazole and amphotericin B were done based on the NCCLS guidelines for antifungal susceptibility testing. The fluconazole resistance pattern was as follows: 1/16 (6.25%) strain of C. albicans was susceptible, 12/16 (75%) strains were dose dependent susceptibles, and 3/16 (18.75%) were resistant to fluconazole. Among Candida tropicalis, 2/7(29%) strains were susceptible, 4/7 (55.5%) dose dependent susceptible and 1/7 (14.5%) were resistant. All strains of C. krusei were resistant to fluconazole. There was no resistance to amphotericin B.
Insights
This study identified Candida infections in neonates, finding Candida albicans, C. tropicalis, and C. krusei. Most isolates showed resistance to fluconazole, but none to amphotericin B, highlighting treatment challenges.
Area of Science:
- Medical Mycology
- Neonatal Infectious Diseases
- Antimicrobial Resistance
Background:
- Neonatal candidiasis is a significant concern in intensive care units.
- Risk factors in neonates include prematurity, low birth weight, and broad-spectrum antibiotic use.
- Candida species are common causes of invasive fungal infections in vulnerable infant populations.
Purpose of the Study:
- To identify Candida species causing bloodstream infections in neonates.
- To determine the antifungal susceptibility patterns of isolated Candida species.
- To evaluate resistance to fluconazole and amphotericin B in neonatal Candida isolates.
Main Methods:
- Blood culture samples from 30 neonates were analyzed for Candida species identification.
- Clinical data including birth weight, gestational age, and prior antibiotic therapy were collected.
- Antifungal susceptibility testing was performed using NCCLS guidelines for fluconazole and amphotericin B.
Main Results:
- Candida albicans (53.3%), Candida tropicalis (23.3%), and Candida krusei (23.3%) were the predominant species.
- High rates of fluconazole resistance were observed: 18.75% of C. albicans, 14.5% of C. tropicalis, and 100% of C. krusei.
- No resistance to amphotericin B was detected among any of the isolated Candida species.
Conclusions:
- Candida bloodstream infections in neonates are often caused by species with emerging resistance to fluconazole.
- Fluconazole resistance in C. krusei is a significant finding, necessitating alternative treatment strategies.
- Amphotericin B remains a reliable treatment option, showing no resistance in this neonatal cohort.
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