Pediatrics, Neonatology & Primary Care

Biography

Biography: Harish C Gugnani

Abstract

The incidence of candidemia has increased worldwide over the last more than five decades due to increasing population of immunocompromised hosts and advances in medical procedures. Nosocomial candidemia is a major cause of neonatal morbidity and mortality. The incidence of candidemia in Asia ranges from 0.026 to 4.2 per 1000 admissions. Its exact prevalence in India is not known due to paucity of systematic epidemiological. In PG Institute of Medical Education & Research, Chandigarh, 143 neonates were diagnosed to have acquired systemic candidiasis out of a total 4,530 admissions (3.2%). Though C. albicans is the most frequent etiological agent of candidemia in neonates in India, there has been increased prevalence of other Candida spp., notably C. tropicalis, followed in order of frequency by C. glabrata, C. parapsilosis, C. krusei and C. guillermondii. In a couple of studies C. tropicalis was more frequent etiological agent of neonatal candidemia than C. albicans. Also C. glabrata predominated among non-C. albicans species in a few of the investigations. Further, C. aureus has recently emerged as an important cause of neonatal candidamia in India. Multiple risk factors for neonatal candidemia include low birth weights less than 1250 g, prolonged indwelling intravascular catheters and central venous catheters, intrapartum use of antibiotics (often prolonged), unclean vaginal examination, parenteral nutrition, ventilator support and prior Candida colonization and inherent resistance to fluconazole observed in C. kruei and C. glabrata. It conclusion it can be said that neonatal candidemia in a challenging problem in India. We should prevent it by identifying risk factors in hospital settings and minimizing their level, implementation of hand washing procedures and precise identification of causative Candida species and in vitro antifungal susceptibility tests for formulation of effective therapy.