Candida colonization in neonates admitted to neonatal intensive care unit (NICU) in Mosul

Background: Candida species are important nosocomial pathogens in the newborns, particularly among the preterms. Colonization of the neonatal skin and gastrointestinal tract is the first step in the pathogenesis of invasive Candidiasis. Colonization of the infant occurs early in life and this is affected by a variety of common practices in the neonatal intensive care unit (NICU). Objective: To determine colonization of Candida species in neonates admitted to NICU in Mosul city, and to identify the possible risk factors for colonization. Patients and methods: A case series study was conducted in a Al Khansaa Teaching Hospital in Mosul city between September 2012 to March 2013. Fifty neonates who were admitted for several causes and stayed in the hospital for seven or more days were included in the study. Sterile cotton tipped swabs from oral, rectal and umbilical areas of each neonate were collected within 24 hours of admission, day five, day seven or thereafter when the neonate was discharged from hospital. Swabs were smeared on the surface of plates of Sabourauds glucose agar. Data was analyzed using Students "t" test, Chi-square test and Fisher's exact test wherever necessary. Results: Candida colonization was seen in 70% of patients at different sites and times of samples collection. Colonization was more common in males than females. From the colonized neonates, 60% were full term and 40% were premature, and 74% had normal birth weight and 26% had low birth weight. Acquisition of Candida occurred in 63% of neonates within the first 24 hrs and by day five 94% of neonates were colonized. The remaining 6% were colonized after fifth days of admission. Male sex, normal birth weight and signs of vaginal candidiasis in the mother were found to be significant risk factors for neonatal colonization. Conclusion: Candida colonization was seen in 70% of the study sample. Male neonates were colonized more often than females. Male sex, normal birth weight and signs of maternal vaginal candidiasis were significant risk factors for neonatal colonization with Candida.