Emerging Predominance of Candida Species in Neonatal Sepsis: A Retrospective Analysis from a Tertiary Care Neonatal Intensive Care Unit

Background: Neonatal sepsis remains a major cause of morbidity and mortality in neonatal intensive care units (NICUs) worldwide. Historically, bacterial pathogens have dominated the aetiological landscape; however, Candida species are increasingly being identified as a significant cause of culture-positive sepsis, particularly in preterm and very low birth weight (VLBW) neonates. Data from resource-limited tertiary care NICUs regarding the precise burden and risk profile of Candida sepsis remain sparse. Material and Methods: This retrospective observational study analyzed 957 episodes of culture- positive neonatal sepsis specimen received in the Department of Microbiology from thr NICU of a tertiary care hospital between January 2024 to December 2025. Demographic, clinical, and microbiological data were extracted. Organisms were categorized as Candida or non-Candida. Associations between Candida sepsis and clinical variables—including birth weight, gestational age, and prior antibiotic exposure—were evaluated using chi-square tests and multivariate logistic regression. Results: Of 957 culture-positive episodes, Candida species accounted for 410 (42.8%), making it the single most frequently isolated organism. Among bacterial pathogens, methicillin-resistant coagulase-negative staphylococci (MRCONS, 14.6%), methicillin- resistant Staphylococcus aureus (MRSA, 13.1%), Acinetobacter baumannii (8.6%), Klebsiella pneumoniae (7.1%), and Burkholderia cepacia (7.1%) were prominent. Candida sepsis was significantly associated with VLBW (OR 3.1; 95% CI 2.3–4.1), preterm birth (OR 2.9; 95% CI 2.2–3.9), and prior broad-spectrum antibiotic exposure with two or more agents (OR 6.1; 95% CI 4.1–9.1). Bacterial isolates demonstrated extensive drug resistance, with Acinetobacter and Burkholderia cepacia showing pan- resistant phenotypes in a substantial proportion of cases. Conclusion: Candida species have emerged as the predominant pathogen in this NICU, surpassing traditional bacterial causes of neonatal sepsis. These findings underscore the critical need for heightened antifungal surveillance, early empirical antifungal consideration in high-risk neonates, and robust antibiotic stewardship programs in tertiary care settings.

Keywords: Neonatal sepsis; Candida; VLBW; NICU; antifungal; antibiotic stewardship; drug resistance.