Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 55600
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size

  Table of Contents    
Year : 2012  |  Volume : 55  |  Issue : 1  |  Page : 132-133
Neonatal candidemia: A changing trend

1 Department of Microbiology, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
2 Department of Paediatrics, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India

Click here for correspondence address and email

Date of Web Publication11-Apr-2012

How to cite this article:
Sardana V, Pandey A, Madan M, Goel S P, Asthana AK. Neonatal candidemia: A changing trend. Indian J Pathol Microbiol 2012;55:132-3

How to cite this URL:
Sardana V, Pandey A, Madan M, Goel S P, Asthana AK. Neonatal candidemia: A changing trend. Indian J Pathol Microbiol [serial online] 2012 [cited 2023 Sep 26];55:132-3. Available from:


Candidemia is a significant cause of mortality and morbidity in neonates admitted in the neonatal intensive care units (NICUs). [1] Systemic candidiasis in neonates is increasing in frequency, especially because the survival of babies with low-birth weight has increased. Candida species are the most common fungal pathogen isolated from the blood culture of neonates. A number of risk factors are associated with the development of neonatal systemic candidiasis, such as low-birth weight babies, prematurity, prolonged antibiotic therapy, parentral nutrition and artificial ventilation. [2] Respiratory insufficiency, apnea, bradycardia, temperature instability, feeding intolerance and abdominal distension are the various clinical manifestations associated with candidiasis. [2],[3] Prompt treatment with antifungals is required in these babies. Limited data regarding the pattern of neonatal candidemia from this part of the country prompted us to undertake the present study to assess the changing trend of neonatal candidemia from Meerut city and to correlate the various risk factors and clinical presentations associated with it in our setting.

A total of 527 blood samples of clinically diagnosed septicemic neonates was collected over a period of 1 year from the NICU of Subharti Medical College, Meerut. The blood sample inoculated in the BacT/ALERT 3D pediatric culture bottle was incubated in an automated microbial detection system (bioMerieux) for up to 5 days at 37 o C. Any growth indicated was subcultured on sheep blood agar, MacConkey agar plates and Sabouraud dextrose agar slant with antibiotics but without cycloheximide (Hi-Media Pvt. Ltd., Mumbai, India). Candida species isolated were identified as per standard mycological techniques. [4]

A total of 365/527 (69.3%) cases were blood culture positive. Pure growth of Candida species was isolated from 110/365 (30.1%) cases. Pure growth of bacteria and mixed growth of bacteria and yeast were isolated from 196/365 (53.7%) and 59/365 (16.2%) of the cases, respectively. Candidaemia was defined as the presence of at least one positive blood culture containing pure growth of Candida species with supportive clinical features.

Because of advances in medical and surgical management, an increase in nosocomial fungal infection rate has been observed. In the present study, we report candidemia in 30.1% cases of neonatal septicemia. The finding is comparable to the frequency reported by other workers. [1],[2]

As per the initial reports, most cases of neonatal candidemia were caused by Candida albicans. However, recent studies from different regions of India have shown changing trends of neonatal candidemia, with emergence of non-albicans Candida (NAC) species as an important cause of neonatal septicemia. The present study also emphasizes the changing trends of Candida species, with predominance of NAC (86.4%) in cases of neonatal septicemia from Meerut city. Our result is comparable with a previous study carried out by Agarwal et al., [5] where NAC was isolated in 84.4% cases from Lucknow, another city in Uttar Pradesh. Similarly, increasing rates of NAC have been reported by various workers from different regions of India. [1],[2],[6]

Candida glabrata (39%) was the predominant NAC species isolated in our setting, followed by C. tropicalis (26.4%), C. parapsilosis (14.5%), C. guilliermondii (2.7%), C. krusei (1.8%), C. dubliniensis (0.9%) and C. lusitaniae (0.9%) [Table 1]. NAC species, especially C. tropicalis, C. krusei, C. glabrata and C. parapsilosis, tend to be less-susceptible to azoles, particularly fluconazole, than C. albicans. C. krusei is innately resistant to fluconazole. Studies have also revealed an inherent fluconazole resistance in C. glabrata thus emphasizing the need to identify Candida up to the species level, especially in the high-risk population.
Table 1: Distribution of various Candida species isolated from blood in cases of neonatal candidemia (n=110)

Click here to view

We retrospectively correlated our results of candidaemia with the clinical presentation of the neonates and associated risk factors. It was observed in the present study that respiratory distress (74.55%) (P<0.01) was the most common clinical presentation, followed by failure to thrive (70%) (P<0.01), lethargy (64.55%) (P<0.01) and feed intolerance (60.91%) (P<0.05) [Table 2]. Bleeding tendency (57.27%) and convulsions (43.64%) were the less-common clinical features (P > 0.05) seen in our cases. Similar findings have been reported in the past. [2],[3] Low-birth weight was the most common risk factor (79.09%) (P<0.01) seen in our cases, followed by prematurity (67.27%) (P<0.01). Prolonged intravenous antibiotics (49.09%) (P>0.05), ventilatory support (47.27%) (P>0.05), prolonged hyperalimentation (30%), corticosteroid therapy (13.64%) and prolonged central venous line (10.91%) were less-common risk factors observed (P<0.01) in our study.
Table 2: Various clinical presentations observed in cases of neonatal candidemia (n=110)

Click here to view

To conclude, the present study emphasizes the mycological shift of Candida species in neonatal candidemia with predominance of NAC species from Meerut city, definitely a changing trend (P<0.01) [Table 3]. Thus, reporting of fungal blood stream infection and the spectrum of species involved are essential measures in any intensive care unit in order to implement appropriate preventive and therapeutic strategies. As various risk factors for neonatal candidaemia in a high-risk population have been identified, our study further emphasizes that appropriate measures must be taken to reduce the risk factors wherever possible.
Table 3: Potential risk factors identified in cases of neonatal candidemia (n=110)

Click here to view

   References Top

1.Rani R, Mohapatra NP, Mehta G, Randhawa VS. Changing trends of Candida species in neonatal septicemia in a tertiary North Indian hospital. Ind J Med Microbiol 2002;20:42-4.  Back to cited text no. 1
2.Narain S, Shastri JS, Mathur M, Mehta PR. Neonatal systemic Candidiasis in a tertiary care centre. Ind J Med Microbiol 2003;21:56-8.  Back to cited text no. 2
3.Ariff S, Saleem AF, Soofi SB, Sajjad R. Clinical spectrum and outcomes of neonatal candidiasis in a tertiary care hospital in Karachi, Pakistan. J Inf Dev Ctries 2011;5:216-23.  Back to cited text no. 3
4.Moore GS, Jaciow DM. Mycology for the Clinical Laboratory. Reston, Virginia: Reston Publishing Company Inc.; 1979. p. 323.  Back to cited text no. 4
5.Agarwal J, Bansal S, Malik GK, Jain A. Trends in neonatal septicemia: Emergence of non-albicans Candida. Indian Pediatr 2004;41:712-5.  Back to cited text no. 5
6.Chakrabarti A, Singh K, Das S. Changing face of nosocomial candidemia. Ind J Med Microbiol 1999;17:160-6.  Back to cited text no. 6

Correspondence Address:
Anita Pandey
Department of Microbiology, Subharati Medical College, Subharatipuram, Swami Vivekanand Subharti University, Meerut - 250 005, Uttar Pradesh
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.94900

Rights and Permissions


  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 Spectrum and Antifungal Resistance of Candidemia in Neonates With Early- and Late-Onset Sepsis in Pakistan
Salima Rattani, Joveria Farooqi, Ali Shabbir Hussain, Kauser Jabeen
Pediatric Infectious Disease Journal. 2021; 40(9): 814
[Pubmed] | [DOI]
2 Risk factors and biofilm formation analyses of hospital-acquired infection of Candida pelliculosa in a neonatal intensive care unit
Zhijie Zhang, Yu Cao, Yanjian Li, Xufang Chen, Chen Ding, Yong Liu
BMC Infectious Diseases. 2021; 21(1)
[Pubmed] | [DOI]
Navdeep Gambhir, Abhigyan Goel, Anita Pandey, Arjun Singh Bisht, Sadab Khan, Deepali Saini
[Pubmed] | [DOI]
4 Candida Species Causing Neonatal Septicaemia - Experience in a Tertiary Care Centre
Supriya Sneha Lakra, Vasant P. Baradkar, Jayanthi S Shastri, Anuradha De
Journal of Evolution of Medical and Dental Sciences. 2020; 09(01): 38
[Pubmed] | [DOI]
5 Clinical and laboratory characteristics of Neonatal Candida sepsis
Devleta Hadžic, Fahrija Skokic, Selmira Brkic, Amina Saracevic
Sanamed. 2019; 14(3): 259
[Pubmed] | [DOI]
6 Candida blood stream infection in neonates: Experience from a tertiary care teaching hospital of Central India
Sriparna Basu,Rajesh Kumar,Ragini Tilak,Ashok Kumar
Indian Pediatrics. 2017; 54(7): 556
[Pubmed] | [DOI]
Vaibhav Misra, Himanshi Bansal, Sanjay Singh Kirar
Journal of Evidence Based Medicine and Healthcare. 2016; 3(47): 2326
[Pubmed] | [DOI]
8 Syndrome Evaluation System (SES) versus Blood Culture (BACTEC) in the Diagnosis and Management of Neonatal Sepsis - A Randomized Controlled Trial
B. Vishnu Bhat,P. Prasad,Venkata Banda Ravi Kumar,B. N. Harish,K. Krishnakumari,Anand Rekha,G. Manjunath,B. Adhisivam,B. Shruthi
The Indian Journal of Pediatrics. 2016; 83(5): 370
[Pubmed] | [DOI]
9 Invasive candidiasis in non neutropenic critically ill - need for region-specific management guidelines
A. K. Baronia, Rungmei S.K. Marak
Indian Journal of Critical Care Medicine. 2015; 19(6): 333
[Pubmed] | [DOI]
10 Oral colonization: A possible source for candidemia in low-weight neonates
G.C.M. Batista,V.L.J. Krebs,L.S. Ruiz,M.E. Auler,R.C. Hahn,C.R. Paula
Journal de Mycologie Médicale / Journal of Medical Mycology. 2014;
[Pubmed] | [DOI]
11 Background changing patterns of neonatal fungal sepsis in a developing country
D. E. Ballot,N. Bosman,T. Nana,T. Ramdin,P. A. Cooper
Journal of Tropical Pediatrics. 2013;
[Pubmed] | [DOI]
12 Emergence of non-albicans Candida species in neonatal candidemia
Juyal, D., Sharma, M., Pal, S., Rathaur, V.K., Sharma, N.
North American Journal of Medical Sciences. 2013; 5(9): 541-545
13 Fungemia by Candida pelliculosa (Pichia anomala) in a Neonatal Intensive Care Unit: A Possible Clonal Origin
Carolina Maria da Silva,Ana Maria Rabelo Carvalho Parahym,Mariele Porto Carneiro Leão,Neiva Tinti Oliveira,Rosemary Jesus Machado Amorim,Rejane Pereira Neves
Mycopathologia. 2013; 175(1-2): 175
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  

    Article Tables

 Article Access Statistics
    PDF Downloaded312    
    Comments [Add]    
    Cited by others 13    

Recommend this journal