Neonatal candiduria: does it jeopardize the outcome of infants at risk in Cairo University Neonatal Intensive Care Units (NICUs)?

Background: There is limited information on neonatal candidal urinary tract infection (UTI). Predisposing factors are prematurity, antimicrobial agents, and prolonged hospital stay. Objectives: To discuss the prevalence of candiduria among the risky neonates, to evaluate which of the predisposing factors has the highest risk of candiduria in Cairo University NICUs. We also tried to figure out the incidence of early complications (candidiasis and renal candidiasis) among candiduric neonates. Patients and Methods: We prospectively studied 50 neonates at risk [with gestational age (GA) 30-39 weeks] from Neonatal Intensive Care Units NICUs of Cairo University between January 2009 and September 2009. Urine samples were collected by sterile urethral catheterization under complete aseptic precautions. Studied cases were divided according to presence of candida in urine into two main groups: 1Group I (with candiduria) (n=16) [10 fullterm (FT) and 6 preterm (PT)]. 2Group II (without candiduria) (n=34). Blood cultures, Kidney function tests and renal ultrasound were ordered for certain cases to exclude candidiasis. Results: The incidence of candiduria among neonates at risk was 32% of case. There was no significant difference between the two groups as regard GA sex, duration of either hospital stay, or antibiotic therapy. However, certain antibiotic combinations were associated with higher incidence of candiduria. Conclusion: Neonatal candidal UTI, may be associated with morbidity and mortality. Routine urine analysis (especially for neonates with risk factors) is recommended to start antifungal therapy. Periodic re-evaluation of the feedback of antibiotic therapy protocols-in NICUsis mandatory.