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Year : 2002  |  Volume : 20  |  Issue : 1  |  Page : 42-44

Changing trends of candida species in neonatal septicaemia in a tertiary North Indian hospital

Department of Microbiology, Lady Hardinge Medical College, New Delhi-110 001, India

Correspondence Address:
Department of Microbiology, Lady Hardinge Medical College, New Delhi-110 001, India

 ~ Abstract 

Four hundred and fifty four blood samples of clinically diagnosed septicemic neonates were collected over a period of six months from the neonatal ICU of Kalawati Saran Children Hospital, New Delhi. 144 samples were culture positive; out of which 50 (34.7%) were Candida isolates. 92% isolates were Candida tropicalis, 4% were C. albicans and C. kefyr each. The study emphasises the changing pattern of Candida species and their importance in blood stream infections in neonates.

How to cite this article:
Rani R, Mohapatra N P, Mehta G, Randhawa V S. Changing trends of candida species in neonatal septicaemia in a tertiary North Indian hospital. Indian J Med Microbiol 2002;20:42-4

How to cite this URL:
Rani R, Mohapatra N P, Mehta G, Randhawa V S. Changing trends of candida species in neonatal septicaemia in a tertiary North Indian hospital. Indian J Med Microbiol [serial online] 2002 [cited 2021 Jan 22];20:42-4. Available from:

In the neonatal intensive care units infection with unusual organisms is an increasing problem. Due to advances in medical and surgical management an increase in nosocomial fungal infection rate has been observed.[1],[2] Among the fungal pathogens Candida species is the most common nosocomial pathogen. More than 100 species of candida have been identified, but only a few species have been isolated from humans. C. albicans is the most commonly isolated species and accounts for 50-70% of cases of invasive candidiasis.[3],[4] But the recent studies suggest that with the introduction of fluconazole and itraconazole, there is an increase in the prevalence of non albicans candidial septicemia.[5] Infection with Candida tropicalis, Candida parapsilosis and other Candida species are increasing.[6] Systemic candidiasis causes problems in presentation, which may be indistinguishable from bacterial septicemia. These infections are severe, difficult to diagnose and refractory to therapy. In an Indian study Candida attributed deaths occurred in 17% of cases.[7] The present study was conducted to assess the changing trends of candidaemia in neonates.

 ~ Materials and Methods Top

A total of 454 clinically diagnosed cases of septicemia of neonatal ICU in Kalawati Saran Children Hospital, New Delhi were studied between January to June 2000. Blood samples were collected aseptically into glucose broth and incubated at 370C upto 10 days. Subcultures were made on blood agar and MacConkeys agar. Candida species were isolated from 50 cases which were further confirmed by (a) germ tube production,[8] (b) growth on corn meal agar (DIFCO, USA) and pigmentation on TTZ (2,3,5-triphenyl tetrazolium chloride, Hi-Media, India),[8] (c) sugar assimilation tests[8] (Hi-Media) as per standard techniques. Candidaemia was defined as the presence of at least one positive blood culture containing Candida species with supportive clinical features.

 ~ Results Top

Out of 454 neonates, 144 were culture positive (Male-95, Female-49) and bacteria were isolated from 94 cases (65.2%) and Candida species from 50 cases [Table - 1]. [Table - 2] shows details of carbohydrate assimilation reactions; and pigmentation on TTZ plate of various Candida species. C. tropicalis was isolated from 46 cases and was the most predominant species (statistically significant x2=13.4). C. albicans and C. kefyr were isolated from 2 cases each. The highest incidence of C. tropicalis was observed during May-2000. Out of 454 neonates admitted to the hospital 55.7% had clinically suspected neonatal septicemia (NNS), 28.2% were pre-term babies with NNS, and 16.1% were low birth weight babies.

 ~ Discussion Top

Kalawati Saran Children Hospital, New Delhi is one of the largest children hospital in Asia. Among the 34.7% of candidal septicemia cases, C. tropicalis was the most common isolate (92%) followed by C. albicans and C. kefyr (4% each). In our study isolation rate of Candida species in neonatal septicemia was higher than a similar study conducted in Medical College Hospital, Calcutta.[9] Another study in Chandigarh, revealed that non-albicans Candida species was isolated from 75% cases of candidaemia and C. tropicalis was the commonest agent.[10] In a study conducted in Israel C. tropicalis was isolated from 29 blood cultures of 6 premature infants which is similar to our findings.[11]
According to National Nosocomial Infection Surveillance (NNIS), USA in 1990s Candida species remained the 4th most common blood stream pathogen accounting for 8% of all hospital acquired blood stream infections and more than 1/3rd of these infections were due to species of Candida other than C. albicans.[12] Pfaller reported that cases due to non-albicans Candida species ranged from 14-100% and was 46% overall.[13] A National surveillance programme of nosocomial blood stream infection in USA showed 48% of candidaemia were due to non-albicans Candida species and C. tropicalis was isolated from 11% of cases.[14] Candidaemia in neonates is most commonly due to C. albicans but our study demonstrated that only 4% of isolates were C. albicans. It has also been found that 4% of Candidaemia was due to C. kefyr which is a new species gaining importance as a nosocomial pathogen in tertiary care hospitals. There are multiple risk factors which are responsible for emergence of neonatal candidaemia in recent years. These include the wide use of broad spectrum antibiotics, loss of mucosal immunity, colonization, umbilical vessel catheterization, length of hospital stay and very importantly low birth weight.[7],[15],[16],[17]
In conclusion, non-albicans Candida species are assuming an increasing role in nosocomial infections in neonates and the findings of this study highlight the increased isolation rates of C. tropicalis and isolation of new species like C. kefyr

 ~ References Top

1.Bodey GP. The emergence of fungi as a major hospital pathogen. J. Hosp Infect 1988; 11: 411-26.   Back to cited text no. 1  [PUBMED]  
2.Chakrabarti A, Chander J, Kasturi P, Panigrahi D. Candidaemia; a 10 year study in an Indian teaching hospital. Mycoses 1992; 35: 47-50.   Back to cited text no. 2    
3.Pfaller MA. Epidemiology of Candidiasis. J. Hosp Infect 1995; 30 (Suppl): 329-38.   Back to cited text no. 3  [PUBMED]  
4.Jarvis WR. Epidemiology of nosocomial fungal infection, with emphasis on Candida species. Clin Infect Dis 1995; 20: 1526-30.  Back to cited text no. 4  [PUBMED]  
5.Chakrabarty A, Singh K, Das S. Changing face of nosocomial candidaemia. Indian J Med Microbiol 1999; 17: 160-166.  Back to cited text no. 5    
6.Wenzel RP. Nosocomial candidaemia: risk factors and attributable mortality. Clin Infect Dis 1995; 20: 1531-34.   Back to cited text no. 6    
7.Narang A, Agarwal PB, Chakrabarti A, Kumar P. Epidemiology of systemic candidiasis in tertiary care neonatal unit. J Trop. Paed 1998; 44: 104-08.  Back to cited text no. 7    
8.Jagdish Chander. Candidiasis. A text book of Medical Mycology, 1st edn. (New Delhi Interprint) 1996.   Back to cited text no. 8    
9.Roy A, Maiti PK, Adhya S, Bhatacharya A, Chakrabarty G, Ghose E, Chakrabarty P. Neonatal candidemia. Indian J Pediatr 1993; 60: 799-801.   Back to cited text no. 9    
10.Vaideeswar P, Sivaraman A, Deshpande JR. Neonatal candidial endocarditis- a rare manifestation of system candidiasis. Indian J Pathol Microbiol 1999; 43: 165-168   Back to cited text no. 10    
11.Finkelstein R, Reinhertz G, Hashman N, Merzbach D. Outbreak of Candida tropicalis fungemia in a neonatal intensive care unit. Infect Contr Hosp Epidemiol 1993; 14: 587-90.   Back to cited text no. 11  [PUBMED]  
12.Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993; 6; 428-42.   Back to cited text no. 12    
13.Pfaller MA, Epidemiology and control of fungal infection. Clin Infect Dis 1994; 199 (Suppl 1): S8-13.   Back to cited text no. 13    
14.Pfaller MA, Jones RJ, Messer SA, Edmond MB, Wenzel RP. and the SCOPE Participant Group, national Surveillance of Nosocomial blood stream infection due to species of Candida other than Candida albicans: Frequency of occurrence and antifungal susceptibility in the SCOPE Program. Diagn Microbial Infect Dis 1998; 30: 121-129.  Back to cited text no. 14    
15.Fraser VJ, Jones M, Dunkel J, Strofer S, Medoff G, Dunagan C. Candidemia in a tertiary care hospital: epidemiology, risk factors and predictor of mortality. Clin Infect Dis 1992; 15: 414-421.   Back to cited text no. 15    
16.Mac Donald L, Baker C, Chenoweth C. Risk factors for candidemia in a children's hospital. Clin Infect Dis 1998; 26: 6420-645.   Back to cited text no. 16    
17.Cole GT, Abdul A, Halwar, Anaissie EJ. The role of the gastrointestinal tract in haematogenic candidiasis: from the laboratory to the bedside. Clin Infect Dis 1996; 22 (Suppl 2): S73-S88.  Back to cited text no. 17    
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