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Candidemia in Brazilian neonatal intensive care units: risk factors, epidemiology, and antifungal resistance

  • Clinical Microbiology - Research Paper
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Abstract

Candidemia is responsible for substantial morbidity and mortality in neonatal intensive care units and represents a challenge due to the complexity of hospitalized neonates, the deficiency in approved and precise diagnostic techniques, and the increasing number of species resistant to antifungal agents. Thus, the objective of this study was to detect candidemia among neonates evaluating the risk factors, epidemiology, and antifungal susceptibility. Blood samples were obtained from neonates with suspected septicemia, and the mycological diagnosis was based on yeast growth in culture. The fungal taxonomy was based on classic identification, automated system, and proteomic, when necessary molecular tools were used. The in vitro susceptibility tests were performed according to the broth microdilution method from Clinical and Laboratory Standards Institute. Statistical analysis was performed using the R software version R-4.2.2. The prevalence of neonatal candidemia was 10.97%. The major risk factors involved were previous use of parenteral nutrition, exposure to broad-spectrum antibiotics, prematurity, and prior use central venous catheter, but only this last was statistically associated with mortality risk. Species from Candida parapsilosis complex and C. albicans were the most frequent. All isolates were susceptible to amphotericin B, except C. haemulonii that also exhibited elevated MICs to fluconazole. C. parapsilosis complex and C. glabrata exhibit the highest MICs to echinocandins. Considering these data, we emphasize that an effective management strategy to reduce the impact of neonatal candidemia should involve the knowledge of risk factors, rapid and precise mycological diagnostic, and tests of antifungal susceptibility to help in the selection of an appropriate treatment.

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Data Availability

The datasets generated and/or analyzed during the current study are not publicly available to protect our participants’ sensitive data but are available from the corresponding author on reasonable request.

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Acknowledgements

We thank the health professionals from the Neonatal Intensive Care Units from the Clinics Hospital PE and Agamenon Magalhães Hospital, for the support and help with the patient’s data, and Dr. Pauliana Valéria Machado Galvão for the statistical analysis.

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Authors and Affiliations

  1. Medical Course, University of Pernambuco, Gregório Ferraz Nogueira Avenue, José Tomé de Souza Ramos, Serra Talhada, PE, 56909-535, Brazil

    Carolina Maria da Silva

  2. Frassinetti College of Recife, Recife, PE, Brazil

    Ana Maria Rabelo de Carvalho

  3. Mycology Department, Federal University of Pernambuco, Recife, PE, Brazil

    Danielle Patrícia Cerqueira Macêdo & Rejane Pereira Neves

  4. Neonatal Intensive Care Unit, Agamenon Magalhães Hospital, Recife, PE, Brazil

    Moacir Batista Jucá

  5. Maternal and Child Department, Federal University of Pernambuco, Recife, PE, Brazil

    Rosemary de Jesus Machado Amorim

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  1. Carolina Maria da Silva
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Correspondence to Carolina Maria da Silva.

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da Silva, C.M., de Carvalho, A.M.R., Macêdo, D.P.C. et al. Candidemia in Brazilian neonatal intensive care units: risk factors, epidemiology, and antifungal resistance. Braz J Microbiol 54, 817–825 (2023). https://doi.org/10.1007/s42770-023-00943-1

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