Neonatal candidemia over seven years: Epidemiological trends, risk factors, and outcome associations with Paed-EQUAL Candida score adherence.

Candidemia remains a major cause of morbidity and mortality in neonatal intensive care units (NICUs). We aimed to evaluate the epidemiological characteristics and antifungal susceptibility patterns of neonatal candidemia, identify independent risk factors through a matched case-control design, and assess the association between Paed-EQUAL Candida score adherence and clinical outcomes. This retrospective matched case-control study was conducted in a tertiary NICU between 2018 and 2024. Neonates with candidemia were matched 1:2 with controls according to gestational age, birth weight, sex, and mode of delivery. Demographic characteristics, comorbidities, microbiological findings, and Paed-EQUAL Candida scores were analyzed. Seventy-four neonates with candidemia and 148 matched controls were included. Candida albicans accounted for 54.0% of cases. In multivariable analysis, congenital heart disease (OR 21.27), total parenteral nutrition (OR 21.53), and gastrointestinal comorbidities (OR 7.72) were identified as independent risk factors for candidemia (all p < 0.01). Thirty-day mortality was 23.0%. Lower Paed-EQUAL Candida scores were associated with mortality and showed acceptable discrimination for 30-day mortality (AUC 0.705, p = 0.009). Higher Paed-EQUAL Candida scores remained independently associated with improved survival.Conclusion: Neonatal candidemia remains associated with substantial mortality. Congenital heart disease, gastrointestinal comorbidities, and prolonged total parenteral nutrition exposure were independently associated with candidemia. Higher adherence to guideline-based recommendations, as measured by the Paed-EQUAL Candida score, was independently associated with improved survival, supporting the value of standardized evidence-based management in neonatal candidemia. What is Known: • Neonatal candidemia remains a major cause of morbidity and mortality in neonatal intensive care units, making early recognition and timely antifungal treatment crucial for improving outcomes • Understanding local epidemiological trends is essential for identifying high-risk patients and optimizing prevention, diagnostic, and treatment strategies What is New: • In this seven-year matched case-control study, congenital heart disease, gastrointestinal comorbidities, and total parenteral nutrition were identified as independent risk factors for neonatal candidemia • This study is among the first to evaluate the Paed-EQUAL Candida score in neonatal candidemia and demonstrates an association between higher adherence scores and improved survival outcomes.