Outbreak of mucocutaneous Candida infections in newborns: clinical implications, investigation, and control measures

Mucocutaneous fungal infections, particularly oral and genital candidiasis, are the most common fungal diseases in neonatal populations. Although generally mild, non-invasive Candida infections can serve as sources of colonization increasing the risk of progression to invasive candidiasis, especially in preterm neonates.

This study aimed to describe the infection prevention and control (IPC) measures, including contact precautions, disinfection of environment and shared devices and the review of hand hygiene protocols implemented during an outbreak of neonatal Candida spp. infections in a newborn nursery and special care unit of a secondary hospital, and to analyze associated neonatal and maternal risk factors.An observational cohort study was conducted following the identification of an outbreak between April and June 2024. A case was defined as a neonate with clinical signs of oral or genital candidiasis and/or microbiological confirmation from mucosal swabs.

125 neonates and mothers were included, 16 neonates (12.8%) met the case definition. Female sex, small-for-gestational-age status, Apgar score <7, and need for phototherapy were significantly associated with infection. Maternal primiparity also showed a significant association, whereas maternal vaginal Candida colonization and antibiotic exposure did not. After the implementation of IPC measures, decline of cases was observed. All affected neonates received antifungal therapy and recovered fully without progression to invasive disease.

This outbreak demonstrates that even full-term neonates can be at risk for mucocutaneous Candida infection. The application of IPC measures highlights the importance of surveillance, and environmental sanitation in controlling infection transmission.