The association between mycotic pneumonia and neonatal septicemia

Background

Candida species are the fourth most common etiological agents of late-onset infection in the neonatal intensive care unit (NICU) and are responsible for considerable morbidity and mortality.

Objectives

From November 2023 to February 2024, we investigated the association of mycotic pneumonia with septicemia in 60 neonates, and their roles of mycotic pneumonia in the morbidity and mortality of neonates in two NICUs in the Al-Ramadi Teaching Hospital for Maternity and Children.

Methods

All infants in this study had been diagnosed with septicemia and treated with empirical antimicrobial therapy. An early morning nasogastric tube (NG-tube) was used to collect swallowed sputum by suction for culture and sensitivity testing.

Results

The average white blood count for the neonates was 8547 ± 5884.5 cells/mm². The mean C-reactive protein was 39.3 ± 26 mg/l, the mean serum albumin was 2.9 ± 0.2 g/dl and the positive bacterial blood culture was 28 (46.7 %). 9 (15 %) neonates died during the study period. The NG-tube culture identified fungal growth in all samples. Of these, 49 (81.6 %) were identified as Candida albicans, 6 (10 %) as Candida tropicalis, and 5 (8.3 %) as Cryptococcus laurentii. The bacterial culture results from the NG-tube samples identified 13 (21.6 %) patients with gram-positive bacteria and 47 (78.3 %) with gram-negative bacteria.

Conclusion

We found a prevalence of Candida spp. among neonates in addition to microbial oxygen tube contamination, indicating a biosafety breach in the neonatal unit. Mycotic infection requires global attention as a probable cause of respiratory failure in neonatal septicemia.