ORIGINAL ARTICLE Neonatal Candida auris infection: Management and prevention strategies – A single centre experience Jayasree Chandramati, 1 Laleet Sadanandan, 1 Anil Kumar 2 and Sasidharan Ponthenkandath 1 1 Division of Neonatology, and 2 Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, India Aim: Our aim was to identify the clinical features and outcome of multidrug resistant Candida auris (CA) infection in neonates. Methods: This is a retrospective case cohort study of 17 neonates who developed sepsis caused by CA infection in a tertiary care neonatal intensive care unit over 3 years. The risk factors, clinical features, treatment and outcome were studied. Results: The mean gestation was 32.4 Æ 4.9 weeks with overall mortality of 41%. Clinical features were indistinguishable from other causes of sepsis. CA was sensitive to micafungin but resistant to fluconazole and had variable sensitivity to voriconazole and amphotericin. Survival improved to 83% when infants were treated with a combination of micafungin and amphotericin. Non-survivors were of lower birthweights and had other risk factors. Conclusions: The management guidelines and infection control measures are described in this largest series of neonatal CA infection. Treat- ment with a combination of amphotericin and micafungin improved the outcome. Key words: Candida auris; late onset sepsis; neonates; outcome. What is already known on this topic 1 There reports of multidrug resistant Candida auris infection in adults particularly in the ICUs. 2 There is very little information on neonatal Candida auris infection. What this paper adds 1 This cohort study describes the clinical presentations, manage- ment and outcome of neonatal Candida auris infection. 2 Infection control measures are described. Candida auris, a new Candida species first reported in Japan in 2009 is an emerging pathogen that has been isolated in different countries now. 1 C. auris is associated with nosocomial outbreaks in intensive care settings, and is a major concern because of the difficulty in containing the spread of infection in spite of the enhanced infection control measures. A study from India reported that C. auris was responsible for 5.2% of cases of can- didemia isolated from neonatal intensive care unit (ICU) adult patients. 2 Cases of C. auris have been identified in 33 countries across 5 continents. 3–9 Mortality has been reported to be 30–50%. There is scant information on the clinical course and outcome of C. auris infection in high risk neonates. We hereby report a ret- rospective cohort study of C. auris infection in a tertiary care neo- natal intensive care unit and the infection control measures to contain the spread of infection in the neonatal ICU (NICU). Methods This is a retrospective cohort study of neonates who developed C. auris sepsis in a tertiary care NICU during 2016–2017 (24 months). There were 17 cases of C. auris sepsis in neonates. The following variables were studied: gestational age, birthweight, surgical (post-operative) condition, presence of cen- tral line, use of ventilatory assistance (continuous positive airway pressure, ventilator, high flow nasal cannula, nasal synchronised intermittent mandatory ventilation), concomitant treatment for bacterial sepsis, clinical symptoms, post-natal age of onset of symptoms, fluconazole prophylaxis; days to sterilise the blood, type and duration of antifungal therapy; organ involvement; morbidity and mortality outcome including intraventricular hem- orrhage, periventricular leukomalacia, retinopathy of prematu- rity, bronchopulmonary dysplasia, hearing, laboratory data: complete blood count, C - reactive protein (CRP), international normalised ratio (INR), liver and kidney function and short-term neurodevelopmental outcome. Clinical management Symptoms were non-specific and included lethargy, fever, hypo- tonia, unexplained persistent tachycardia, feeding intolerance or abdominal distension, hyperglycaemia, respiratory distress including apnoea or unexplained oxygen desaturations, or Correspondence: Professor Sasidharan Ponthenkandath, Depart- ment of Pediatrics, University of California Riverside School of Medi- cine, 900 University Avenue, Riverside, CA 92521, USA. Fax: +1 951 656 4280; email: psasidha@gmail.com Conflict of interest: None declared. Accepted for publication 27 May 2020. doi:10.1111/jpc.15019 Journal of Paediatrics and Child Health (2020) © 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians) 1