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The Burden of Neonatal Invasive Candidiasis in Low- and Middle-income Countries: A Systematic Review and Meta-analysis

Summary

This study examined fungal blood infections in newborns across low- and middle-income countries, analyzing data from nearly 11,000 cases. Researchers found these infections occur more frequently and have higher death rates in poorer countries compared to wealthy nations. They identified that most infections are caused by Candida fungus species, and many of these fungi have become resistant to fluconazole, the most commonly used treatment drug.

Background

Invasive Candida infection is a significant threat to neonates worldwide, but most evidence comes from high-income countries. The burden and characteristics of neonatal invasive candidiasis (NIC) in low- and middle-income countries (LMICs) remain poorly described. This systematic review aimed to investigate the incidence, case-fatality rates, epidemiology, and etiology of NIC in LMICs.

Objective

To investigate the incidence, case-fatality rates (CFR), epidemiology, and etiology of neonatal invasive candidiasis in low- and middle-income countries through a systematic literature review and meta-analyses.

Results

257 articles included 10,994 NIC cases from 27 LMICs with overall incidence of 2.6% (95% CI, 2.2–3.0), highest in South-East Asia at 6.3%. C. albicans was most common (39.0%), followed by C. parapsilosis (24.8%). Fluconazole resistance was 24.8% overall, with regional variations. Overall CFR was 18.7% (95% CI, 15.5–22.1), ranging from 9.3% to 39.8% across WHO regions.

Conclusion

NIC shows higher incidence and case-fatality rates in LMICs compared to high-income countries, despite affected neonates being less premature. High proportions of fluconazole-resistant isolates and regional disparities in species distribution were observed. Prevention and treatment strategies for NIC need targeted approaches for LMIC settings with integration into broader neonatal sepsis research platforms and infection prevention bundles.
  • Published in:Open Forum Infectious Diseases,
  • Study Type:Systematic Review and Meta-analysis,
  • Source: PMID: 40630934, DOI: 10.1093/ofid/ofaf329
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