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<p>Invasive fungal infections (IFIs) remain underrecognized in low- and middle-income countries due to limited surveillance. This study aims to report the burden of <i>Candida blankii</i> infections detected through ongoing surveillance in the Neonatal Intensive Care Unit (NICU) of a tertiary hospital in Dhaka, Bangladesh. Since August 2022, IFI surveillance in a NICU in Bangladesh enrolled neonates with sepsis who met predefined clinical criteria. Blood samples were collected and processed using the BACT/ALERT 3D system, and fungal isolates were identified with automated identification system. Antifungal susceptibility testing (AFST) was performed on a subset of isolates using E-strip gradient diffusion. Whole-genome sequencing of nine representative <i>C. blankii</i> isolates, initially identified by VITEK MS, confirmed species identification by demonstrating 94% to 99% average nucleotide identity with reference sequences in the NCBI GenBank database. A total of 411 neonates were enrolled, with a mean age of 16 (± 7) days; 39% were male. More than half (225/411, 55%) had positive fungal blood cultures, among which <i>C. blankii</i> was the most common species (126/225, 31%). The isolates showed high MICs to fluconazole and voriconazole but lower MIC values against amphotericin B (AMP) and echinocandins. In-hospital mortality among <i>C. blankii</i> cases was significantly higher than in infections caused by other fungi. Findings indicate a substantial burden of <i>C. blankii</i> in the NICU and underscore the need for improved diagnostics, targeted treatment strategies, and strengthened infection control in resource-limited neonatal settings.</p>

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High burden of Candida blankii (syn.Tardiomyces blankii) bloodstream infections among neonates in an intensive care unit in Bangladesh

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月25日

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  • Tanzir Ahmed Shuvo,
  • Sayeeda Huq,
  • Nusrat Jahan Shaly,
  • Faiyaz Ahmed Khan,
  • Sifat Binte Ibrahim,
  • Md. Shoieb Ul Haque,
  • Fahmida Dil Farzana,
  • Farhat Jaby,
  • Md. Kamrul Islam,
  • Adiba Tasnim,
  • Shams E. Tabriz Bhuiyan,
  • Zakir Hossain Habib,
  • Nandita Banik,
  • Sazzad Bin Shahid,
  • Mahbuba Chowdhury,
  • Tahsinul Amin,
  • Jesmin Akter,
  • Gazi Md. Salahuddin Mamun,
  • Sanzida Khan,
  • Asifa Kumkum,
  • Debashis Sen,
  • Md. Abdul Aleem,
  • Md. Mobarok Hossain,
  • Tasnim Jabin,
  • Mohammad Jubair,
  • Ayesha Afrin,
  • Fardousi Akter Sathi,
  • Mustafizur Rahman,
  • Dilruba Ahmed,
  • Ismet Nigar,
  • Fahmida Chowdhury

摘要

Invasive fungal infections (IFIs) remain underrecognized in low- and middle-income countries due to limited surveillance. This study aims to report the burden of Candida blankii infections detected through ongoing surveillance in the Neonatal Intensive Care Unit (NICU) of a tertiary hospital in Dhaka, Bangladesh. Since August 2022, IFI surveillance in a NICU in Bangladesh enrolled neonates with sepsis who met predefined clinical criteria. Blood samples were collected and processed using the BACT/ALERT 3D system, and fungal isolates were identified with automated identification system. Antifungal susceptibility testing (AFST) was performed on a subset of isolates using E-strip gradient diffusion. Whole-genome sequencing of nine representative C. blankii isolates, initially identified by VITEK MS, confirmed species identification by demonstrating 94% to 99% average nucleotide identity with reference sequences in the NCBI GenBank database. A total of 411 neonates were enrolled, with a mean age of 16 (± 7) days; 39% were male. More than half (225/411, 55%) had positive fungal blood cultures, among which C. blankii was the most common species (126/225, 31%). The isolates showed high MICs to fluconazole and voriconazole but lower MIC values against amphotericin B (AMP) and echinocandins. In-hospital mortality among C. blankii cases was significantly higher than in infections caused by other fungi. Findings indicate a substantial burden of C. blankii in the NICU and underscore the need for improved diagnostics, targeted treatment strategies, and strengthened infection control in resource-limited neonatal settings.