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Neonatal Invasive Candidiasis: Current Concepts

Summary

Serious fungal infections (candidiasis) in newborns have become increasingly difficult to treat, especially in developing countries. The types of fungi causing these infections have changed dramatically, with many now resisting the standard fluconazole treatment. Modern medical care, like proper handwashing, environmental cleaning, and careful line care, is actually more effective at preventing these infections than giving preventive antifungal drugs. Healthcare providers need better tools for quickly identifying which fungal species is causing infection and which drugs will work against it.

Background

Neonatal invasive candidiasis (NIC) is a significant cause of morbidity and mortality in preterm and very low birthweight infants. The epidemiology of NIC has dramatically changed over the past decade, with increasing prevalence of antifungal-resistant Candida species, particularly in low- and middle-income countries.

Objective

This review examines the global changing epidemiology of NIC, the emergence of antifungal-resistant Candida species and outbreaks, current management approaches, and the value of infection prevention and control measures in preventing NIC.

Results

In high-income countries, C. albicans and C. parapsilosis remain predominant, while low- and middle-income countries show higher rates of non-albicans Candida species with significant antifungal resistance. Fluconazole-resistant C. parapsilosis (17-55%) and multi-drug-resistant C. auris are increasingly causing outbreaks, particularly in neonatal intensive care units.

Conclusion

The changing epidemiology of NIC necessitates optimized species identification and susceptibility testing to guide targeted treatment. Infection prevention and control measures are crucial for preventing neonatal Candida colonization and NIC development, with evidence showing greater impact than prophylactic antifungal therapy alone.
  • Published in:Indian Journal of Pediatrics,
  • Study Type:Review,
  • Source: PMID: 40459650, DOI: 10.1007/s12098-025-05593-9
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