Neonatal Candidaemia at Universitas Academic Hospital, Bloemfontein, South Africa

Abstract

BACKGROUND: Candida remains the most common cause of morbidity and mortality during the neonatal period. Knowledge of epidemiology of candida species and their antifungal profile is important to guide empiric therapy. The aim of the study was to characterise and evaluate the antifungal susceptibility of candida species causing neonatal bloodstream infections at Universitas Hospital. Vitek 2 automated system is used for yeast identification and antifungal susceptibility. To determine the accuracy of the results generated, the antifungal susceptibility results were compared to those generated at the reference laboratory in Johannesburg. METHODS: A retrospective, laboratory based study was conducted over a one year period. Isolates from neonates with candidaemia were identified to species-level and antifungal susceptibility testing was performed. Vitek 2 yeast cards were used for identification and antifungal susceptibility testing. Antifungal susceptibility to fluconazole, amphotericin B, and caspofungin obtained in our laboratory were compared to those obtained at the reference laboratory. At the reference laboratory, broth microdilution susceptibility testing was performed. Categorical agreement was calculated for susceptibility results. RESULTS: Overall a total of 45 candida species were detected. Non- albicans candida accounted for 73% of neonatal candidaemia, with Candida parapsilosis being the most prevalent (60%). Candida albicans was the second most common isolate (27%). Overall 23 (85 %) of the Candida parapsilosis isolates tested were resistant to fluconazole. When Vitek 2 antifungal susceptibility was compared to broth microdilution performed at the reference laboratory, CA was 100% for amphotericin B and caspofungin. However, for Candida parapsilosis, the CA for fluconazole was 50% with 4 (18%) major errors and 7 (32%) minor errors. CONCLUSIONS: Candida parapsilosis is the major cause of candidaemia amongst the neonate in this study. Amphotericin B is currently the appropriate empirical drug of choice for treatment of this infection.