Incidence of Candida species colonization in neonatal intensive care unit at Riyadh Hospital, Saudi Arabia

Keywords: Candida colonization, neonatal intensive care unit, pediatric patient
Abstract viewed: 1883 times
PDF downloaded: 426 times
HTML downloaded: 0 times
EPUB downloaded: 929 times


Background: Candida species are important hospital-acquired pathogens in infants admitted to the neonatal intensive care unit (NICU). This study was performed in the NICU of Saudi Arabian Hospital, Riyadh region, KSA to analyze patterns of neonatal Candida colonization as well as to determine the potential risk factors.

Methods: Weekly surveillance fungal cultures of anal area, oral cavity, umbilicus and ear canal of neonates were performed from birth until their discharge from the hospital. Colonization was analyzed for timing, site, species, birth weight and gestational age. Potential environmental reservoirs and hands of health care workers (HCWs) were also cultured monthly for fungi. Antifungal susceptibility of the identified isolates was also determined.

Results: One hundred subjects have been recruited in this study. The overall colonization rate was 51%. Early colonization was found in 27 (27%) neonates whereas 24 (24%) neonates were lately colonized during their stay in NICU. Colonization was more in preterm neonates than in full and post term. Perianal area and oral cavity were the most frequent colonized sites. C. albicans was the main spp. (58.8%) isolated from the neonates followed by C. tropicalis (17.6%), C. glabrata (15.6%), and C. krusei (2%). Of the 51 isolated Candida spp., 68.6% were sensitive to fluconazole, 80% to itraconazole and 64.7% to ketoconazole, while only 33% were sensitive to amphotericin B.

Conclusion: Candida has emerged as a common cause of infections in infants admitted to NICU, and C. albicans is the most commonly isolated candidal species. Neonatal infections caused by non- albicans species occur at a later age during their stay in NICU.


Download data is not yet available.

Author Biography

Mohammed S. Alhussaini, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University

Associate Professor,

Department of Clinical Laboratory Science,

College of Applied Medicla Sciences


  1. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002;110(2Pt1):285-91.

  2. Fridkin SK, Kaufman D, Edwards JR, Shetty S, Horan T. Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995-2004. Pediatrics. 2006;117(5):1680-7.

  3. Manzoni P, Farina D, Leonessa M, d'Oulx EA, Galletto P, Mostert M, et al. Risk factors for progression to invasive fungal infection in preterm neonates with fungal colonization. Pediatrics. 2006;118(6):2359-64.

  4. Mahieu LM, Van Gasse N, Wildemeersch D, Jansens H, Ieven M. Number of sites of perinatal Candida colonization and neutropenia are associated with nosocomial candidemia in the neonatal intensive care unit patient. Pediatr Crit Care Med. 2010;11(2):240-5.

  5. Mendiratta DK, Rawat V, Thamke D, Chaturvedi P, Chhabra S, Narang P. Candida colonization in preterm babies admitted to neonatal intensive care unit in the rural setting. Indian J Med Microbiol. 2006;24(4):263-7.

  6. Farmaki E, Evdoridou J, Pouliou T, Bibashi E, Panagopoulou P, Filioti J, et al. Fungal colonization in the neonatal intensive care unit: risk factors, drug susceptibility, and association with invasive fungal infections. Am J Perinatol. 2007;24(2):127-35.

  7. Clerihew L, Lamagni TL, Brocklehurst P, McGuire W. Candida parapsilosis infection in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2007;92(2):F127-9.

  8. Bendel CM. Colonization and epithelial adhesion in the pathogenesis of neonatal candidiasis. Semin Perinatol. 2003;27(5):357-64.

  9. Kaufman D. Fungal infection in the very low birthweight infant. Curr Opin Infect Dis. 2004;17(3):253-9.

  10. Saiman L, Ludington E, Pfaller M, Rangel-Frausto S, Wiblin RT, Dawson J, et al. Risk factors for candidemia in Neonatal Intensive Care Unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J. 2000;19(4):319-24.

  11. Huang YC, Li CC, Lin TY, Lien RI, Chou YH, Wu JL, et al. Association of fungal colonization and invasive disease in very low birth weight infants. Pediatr Infect Dis J. 1998;17(9):819-22.

  12. Kuzucu C, Durmaz R, Otlu B, Aktas E, Gulcan H, Cizmeci Z. Species distribution, antifungal susceptibility and clonal relatedness of Candida isolates from patients in neonatal and pediatric intensive care units at a medical center in Turkey. New Microbiol. 2008;31(3):401-8.

  13. Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M, Donowitz LG. Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N Engl J Med. 2001;345(23):1660-6.

  14. Clinical and Laboratory Standards Institute/NCCLS. Performance standards for antimicrobial disk susceptibility tests. Approved standard M2-A8. Wayne;PA: National Committee for Clinical Laboratory Standards; 2003.

  15. Sherertz RJ, Gledhill KS, Hampton KD, Pfaller MA, Givner LB, Abramson JS, et al. Outbreak of Candida bloodstream infections associated with retrograde medication administration in a neonatal intensive care unit. J Pediatr. 1992;120(3):455-61.

  16. Kaufman DA, Gurka MJ, Hazen KC, Boyle R, Robinson M, Grossman LB. Patterns of fungal colonization in preterm infants weighing less than 1000 grams at birth. Pediatr Infect Dis J. 2006;25(8):733-7.

  17. Mohamed SA, Ibrahim HM, Ahmed AE, El-Sayied SB. Pattern of fungal colonization in critically ill pediatric patients in Ain Shams Pediatric 1CU. Pediatric thesis, Egypt: Ain Shams University, Faculty of Medicine; 2009. Pp 35-67.

  18. Al-Tawfiq JA. Distribution and epidemiology of Candida species causing fungemia at a Saudi Arabian hospital, 1996-2004. Int J Infect Dis. 2007;11(3):239-44.

  19. Agvald-Ohman C, Klingspor L, Hjelmqvist H, Edlund C. Invasive candidiasis in long-term patients at a multidisciplinary intensive care unit: Candida colonization index, risk factors, treatment and outcome. Scand J Infect Dis. 2008;40(2):145-53.

  20. Segal, E. and Clad, D. Candida species and Blastoschizomyces capitus. In Topley and Wilson's Microbiology and Microbial infections. 9th ed. Medical Mycology: London; 1998, p. 423-60.

  21. Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TM, Rompalo A, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004;351(9):876-83.

  22. Resende JC, de Resende MA, Saliba JL. Prevalence of Candida spp. in hospitalized patients and their risk factors. Mycoses. 2002;45(8):306-12.

  23. Krcmery V, Barnes AJ. Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance. J Hosp Infect. 2002;50(4):243-60.

  24. Chandra J, Kuhn DM, Mukherjee PK, Hoyer LL, McCormick T, Ghannoum MA. Biofilm formation by the fungal pathogen Candida albicans: development, architecture, and drug resistance. J Bacteriol. 2001;183(18):5385-94.

  25. Baley JE. Neonatal candidiasis: the current challenge. Clin Perinatol. 1991;18(2):263-80.

  26. Bendel CM. Colonization and epithelial adhesion in the pathogenesis of neonatal candidiasis. Semin Perinatol. 2003;27(5):357-64.

  27. Roilides E, Farmaki E, Evdoridou J, Francesconi A, Kasai M, Filioti J, et al. Candida tropicalis in a neonatal intensive care unit: epidemiologic and molecular analysis of an outbreak of infection with an uncommon neonatal pathogen. J Clin Microbiol. 2003;41(2):735-41.

How to Cite
Alhussaini MS. Incidence of Candida species colonization in neonatal intensive care unit at Riyadh Hospital, Saudi Arabia. Med J Indones [Internet]. 2016Oct.14 [cited 2024Jun.16];25(3):171-81. Available from:
Clinical Research