Neonatal Candida glabrata sepsis: clinical and laboratory features compared with other Candida species

Background. Recent studies have shown a rise in Candida glabrata infections among immunocompromised adults. In published case series of neonatal candidemia, however, the species glabrata is uncommon. We conducted a retrospective chart review to examine the epidemiology, clinical presentation and outcome of neonatal infection with C. glabrata compared with other species of Candida. Methods. Neonatal and microbiology databases of two affiliated hospitals were searched for all cases of candidemia in neonatal intensive care unit patients with suspected sepsis from 1991 through 1998. Results. Of 58 cases of Candida sepsis, 9 (15%) were caused by C. glabrata (CG), 41 (71%) by C. albicans (CA) and 8 (14%) by C. parapsilosis (CP). There was no change in the proportion of candidemia caused by glabrata species in the years studied. Although there was a significantly higher proportion of CG cases at 1 hospital (29% vs. 6%, P = 0.01), there was no case clustering to suggest direct nosocomial spread. Compared with other Candida species, CG occurred in infants of higher gestational age (CG 29.7 weeks, CA 26.6 weeks, CP 27.3 weeks) and birth weight (CG 1442 g, CA 931 g, CP 965 g). Patients with CG sepsis were more likely to be receiving broad spectrum antibiotics at the time of diagnosis (CG 67%, CA 38%, CP 38%), were less likely to present with apnea and had less severe thrombocytopenia. Of 9 patients with CG sepsis, I had meningitis, 1 had necrotizing enterocolitis and 3 had candiduria. Conclusion. C. glabrata is a significant nosocomial pathogen in the neonate.