Abstract:

Objective This study aims to analyze the risk factors for the occurrence of neonatal candidemia and those associated with poor prognosis, thereby providing evidence for clinical diagnosis and treatment. Methods This retrospective study enrolled consecutive 57 cases of neonatal candidemia diagnosed by blood culture in the neonatal ward of Shanghai Children's Hospital between January 2017 and December 2024. All included neonates aged ≤28 days at the time of infection. The clinical features, laboratory findings, and treatment outcomes were analyzed. According to outcomes, the neonates were divided into death group (5 cases) and improved group (52 cases), and the risk factors for poor prognosis were analyzed. Results Among the 57 neonates with candidemia, 30 were male and 27 were female. The median postnatal age at the onset of candidemia was 14 days (interquartile range, 10, 20). Forty-eight cases (84.21%) were preterm infants (<37 weeks), 46 cases (80.7%) were low birth weight infants (<2 500 g), 54 cases (94.7%) had a history of invasive examination and treatment procedures before the onset of candidiasis, and 55 cases (96.5%) had a history of antimicrobial agent use prior to candidiasis. Etiological analysis showed that the predominant Candida species infecting the neonates was Candida parapsilosis (46 cases, 80.7%), follower by Candida albicans (6 cases, 10.53%), Candida glabrata (3 cases, 5.26%), and Candida guilliermondii (2 cases, 3.51%). Drug susceptibility test results indicated there was no antifungal drug-resistant strains. The time from the onset of clinical symptoms to confirmed diagnosis and initiation of antifungal therapy was (2.3±1.2) days, and the duration of antifungal treatment was 29 days (interquartile range, 23, 37). Univariate analysis showed that septic shock, tracheal intubation/mechanical ventilation, decreased platelet (PLT) count, and elevated procalcitonin (PCT) were risk factors for poor prognosis of neonatal candidemia (P<0.05). Conclusions The risk factors for neonatal candidemia include prematurity, low birth weight, a history of invasive examination and treatment procedures, and a history of antimicrobial drug use. The predominant pathogenic Candida species is Candida parapsilosis. Septic shock and endotracheal intubation/mechanical ventilation are risk factors for poor prognosis of neonatal candidemia. PLT and PCT can serve as important reference indicators for evaluating the prognosis of neonatal candidemia.

Key words: Neonate, Candidemia, Candida parapsilosis, Prognostic risk factors