Invasive candidiasis (IC) is a leading infectious cause of morbidity and mortality in premature infants. The objective of this study was to determine the prevalence of IC in newborns in the neonatal intensive care unit (NICU) of a tertiary hospital in Japan, and to identify specific predisposing factors for IC.
We retrospectively collected data on demographics, clinical characteristics, and outcomes of infants with IC, who were discharged from a tertiary NICU in Japan between January 2009 and December 2020. We compared predisposing factors associated with the occurrence of early-onset IC (EOIC, < 72 hours) and late-onset IC (LOIC, ≥ 72 hours) with those of early-onset and late-onset bacterial sepsis, respectively.
Over 12 years, 3,549 infants were admitted to the NICU, including 344 extremely low birth weight (ELBW) infants. Eleven infants (including 9 ELBW infants) had IC (incidence 0.31%), and the mortality rate of IC was 0%. Four (36%) infants had EOIC and 7 (64%) had LOIC. All those with EOIC presented with skin lesions, and 86% with LOIC had thrombocytopenia. Maternal vaginal Candida colonization was a more specific predisposing factor for EOIC, while gestational age < 26 weeks, broad-spectrum antibiotic use, prior bacterial infection, prior gastrointestinal (GI) surgery, and GI diseases were more specific predisposing factors for LOIC.
The findings suggest that maternal vaginal Candida colonization and skin lesions in ELBW infants may contribute to early recognition of EOIC, and LOIC should be suspected if ELBW infants with several predisposing factors of LOIC have thrombocytopenia.

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