Invasive candidiasis in a neonatal intensive care unit in Lagos, Nigeria

Invasive candidiasis has been identified globally as a major cause of morbidity and mortality in neonatal intensive care units (NICU). Systemic candidiasis presents like bacterial sepsis and can involve multiple organs.

The objective of this study was to determine the prevalence of Candida infection in a NICU at a tertiary hospital in Nigeria and to identify its associated risk factors.

The study was a retrospective descriptive study of all cases of culture-proven invasive Candida infection (ICI) in neonates admitted to the NICU over a 4-year period. The study participants were identified from microbiology records of all neonates with a positive Candida culture. Medical records of identified neonates were also reviewed, and relevant information obtained.

Over the 4 years, 2712 newborns were admitted to the NICU. From these, 1182 various clinical samples were collected from babies with features of sepsis and processed in the medical microbiology laboratory. Twenty-seven (2.3%) of the cultures yielded Candida organisms; fifteen of the Candida cultures were from male infants with a male:female ratio of 1.3:1. Bloodstream infection was the most frequent ICI seen in preterm babies (seven [58.3%] out of 12 babies with ICI). Nearly, all (91.7%) affected preterm infants with ICI were <1500 g in weight. All were exposed to invasive procedures and broad-spectrum antibiotics. The case fatality rate among those with ICI was 18.5%.

There was a significant prevalence of invasive candidiasis in high-risk newborns and the incidence increases with increased practices in risk factors such as invasive procedures and antibiotic use and lower gestational age babies with very low birth weight.