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Neonatal Invasive Candidiasis: Current Concepts

Summary

Neonatal invasive candidiasis is a serious fungal infection affecting premature and very low birth weight babies. The types of fungi causing these infections are changing globally, with more resistant strains appearing, especially in lower-income countries. Treatment options are limited by this resistance, making prevention through hygiene and proper hospital practices increasingly important.

Background

Neonatal invasive candidiasis (NIC) is an important cause of morbidity and mortality in preterm and very low birthweight infants, with incidence inversely correlated with gestational age and birth weight. The epidemiology of NIC has dramatically changed with an increase in antifungal-resistant Candida species, particularly in low- and middle-income countries.

Objective

To review the global changing epidemiology of neonatal invasive candidiasis, the emergence of antifungal-resistant Candida species, current management approaches, and the value of infection prevention and control measures in preventing NIC.

Results

Candida albicans and C. parapsilosis remain common in high-income countries, while non-albicans species predominate in low- and middle-income countries with higher antifungal resistance rates. Fluconazole-resistant C. parapsilosis and multi-drug-resistant C. auris are increasingly causing NIC outbreaks, challenging management approaches.

Conclusion

Optimal management of NIC requires species identification and antifungal susceptibility testing. Infection prevention and control measures are crucial for preventing NIC and may be more effective than prophylaxis alone. Current global guidelines need modification to address differential NIC epidemiology between high-income and low- and middle-income countries.
  • Published in:Indian Journal of Pediatrics,
  • Study Type:Review,
  • Source: PMID: 40459650, DOI: 10.1007/s12098-025-05593-9
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