Neonatal candidaemia in Kuwait: a 12-year study of risk factors, species spectrum and antifungal susceptibility

P>A study of candidaemia in neonatal intensive care unit (NICU) over a 12-year period (1995-2006) taking into consideration demographic variables, risk factors, aetiological Candida species and therapeutic outcomes is presented. The yeast isolates were identified by VITEK2 yeast identification system and antifungal susceptibility was determined by E-test. Of 4815 neonates admitted in NICU, 182 cases of candidaemia were detected with an overall prevalence of 4.0% and crude mortality of 27.7%. The annual rate of candidaemia per 1000 admissions was the highest in 1997 (84 cases) and the lowest in 2004 (10 cases). Of the 112 assessable candidaemia cases, 78 (70%) occurred in very low birth weight neonates (< 1500 g), 65 (58%) were born with gestational age of < 30 weeks. The main identifiable risk factors were use of >= 2 antibiotics (87%), total parenteral nutrition for > 5 days (82%), placement of central venous catheter (78%) and prior colonisation with Candida species (54%). Candida albicans and non-albicans Candida species accounted for 43% and 57% of candidaemia cases, respectively, and C. parapsilosis emerged as a predominant species. No fluconazole resistance was observed in C. albicans and C. parapsilosis isolates. This is the first comprehensive study on the epidemiology of neonatal candidiasis in Kuwait.