title: Clinical spectrum, management and outcome of neonatal candidiasis.
abstract: OBJECTIVE
  To identify clinical spectrum, management and outcome of neonatal candidiasis.
  
  
  METHODS
  The retrospective study was conducted at the Shifa International Hospital, Islamabad, Pakistan, and comprised microbiological records of all the babies admitted to the Neonatal Intensive Care Unit from January 2009 to January 2014 that were reviewed to identify those with positive candida cultures. Medical records were analysed for demographic and clinical spectrum features, management and outcome. SPSS 16 was used statistical analysis.
  
  
  RESULTS
  Of the total 1550 neonatal admissions, 560 (36%) had positive cultures, and, of them, candida was isolated in 49(8.8%) neonates. Among them, 13(26%) had candida albicans and the rest had candida species. Majority were males 34(70%), and preterm with 30(61%) being <37 weeks. The mean birth weight was 2000±873 grams. Mean age at admission was 6±7.6 days. Overall, 39(80%) had ≥2 risk factors. The commonest site of isolation was blood in 41(84%). Besides, 32 (65%) received fluconazole alone for treatment. Mean duration of anti-fungal therapy was 10±5 days (range: 1-21 days). Twelve (24%) neonates expired and the cause of death was candida sepsis in 10(20%) cases. Mortality was not significantly associated with gender, place of birth, gestation, risk factors, length of stay, prior antibiotic exposure or receipt of antifungal prophylaxis except those who were ≤1500 grams (p<0.05).
  
  
  CONCLUSIONS
  Approximately one in ten at-risk neonates may develop candida sepsis with high mortality. Early institution of anti-fungal therapy may prove to be life-saving.
authors.affiliation: Department of Paediatrics, Shifa International Hospital, Islamabad.
authors.forename: Ejaz Ahmed
authors.initials: EA
authors.lastname: Khan
authors.affiliation: Department of Paediatrics, Shifa International Hospital, Islamabad.
authors.forename: Shehla
authors.initials: S
authors.lastname: Choudhry
authors.affiliation: Department of Paediatrics, Shifa International Hospital, Islamabad.
authors.forename: Masooma
authors.initials: M
authors.lastname: Fatima
authors.affiliation: Department of Paediatrics, Shifa International Hospital, Islamabad.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Batool
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010154:Pakistan; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents
keywords: Candida albicans, Sepsis, Neonate, Anti-fungal.