Prevalence of Candida colonization in preterm newborns and VLBW in neonatal intensive care unit: role of maternal colonization as a risk factor in transmission of disease

Abstract

Candida species are important nosocomial pathogens in the newborn population, particularly among the premature very low birth weight (VLBW) infants in neonatal intensive care units (NICU). Candida colonization in neonates and subsequent dissemination result in a plenty of morbidity and mortality risks. This work aims to determine the prevalence of Candida species colonization in preterms and VLBW newborns in NICU in Al-Hasa, Kingdom of Saudi Arabia, and detect the relation of maternal colonization as a risk factor for transmitting the disease. Subjects and Methods: One hundred two preterms were included; 70 delivered vaginally (index cases) and 32 delivered by cesarean section (control group). Several swabs from oral, umbilical and anus were taken at birth, at third day and 1 week after birth. High vaginal swabs were also taken from the mother before labor. Results: Candida colonization was detected in 12.8% of index cases. Most of them (88.8%) were detected at the third day after birth. The initial site of colonization was the anus (88.8%) in comparison with oral cavity (66.6%) and the umbilicus (55%). Vaginal delivery and prolonged duration of premature rupture of membranes were significantly positively correlated to neonatal colonization (p < 0.02 and p = 0.02, respectively). The lowest birth weight, gestational age and uses of invasive techniques have the highest significant risk for colonization after birth (p < 0.04, p = 0.03 and p = 0.03, respectively). Candida albicans was the most common species detected (77.7% of the cases). The preterm’s colonization species were all identical to their mother vaginal colonization species. Invasive candidiasis was detected in 22.2% of colonized preterm. Conclusion: Candida colonization has a considerable prevalence among the preterms in our NICU. Besides vaginal delivery, low birth weight and low gestational age could be considered as risk factors for colonization. Early screening of the mothers with preterm labor for Candida and proper management help to avoid colonization with subsequent risk of invasive Candidiasis.

Keywords::

• Candida albicans
• colonization
• extremely low birth weight
• neonatal intensive care unit
• preterm

Acknowledgements

The authors acknowledge Rehan Rafat, resident of neonatology; Sabeena Sadat, resident of obstetrics and gynecology; and all nursing and laboratory staff (Maternal and Children hospital, Al-Hasa, eastern region KSA) for their effective participation and assistance in performing this research.

Declaration of interest: The authors report no conflict of interest.