# Neonatal Candidemia in Latin America: Trends, Resistance, and Prevention Strategies (2008–2025)

## TL;DR

This review examines neonatal candidemia in Latin America, highlighting trends in fungal species, resistance patterns, and prevention strategies from 2008 to 2025.

## Contribution

The paper provides a comprehensive synthesis of candidemia trends and resistance in Latin America, emphasizing regional variations and clinical implications.

## Key findings

- Candida parapsilosis sensu lato is the predominant species in NICUs in Latin America.
- Candida auris has emerged as a multidrug-resistant threat in the region.
- High mortality rates are linked to delayed diagnosis and species-specific characteristics.

## Abstract

Candidemia and invasive candidiasis remain significant causes of late-onset sepsis and mortality in very-low-birth-weight infants, especially in low- and middle-income countries. This narrative review synthesizes studies published between 2008 and 2025 in Latin America, addressing epidemiology, species distribution, antifungal susceptibility patterns, risk factors, therapeutic approaches, and clinical outcomes, with international comparisons. Accordingly, we present a qualitative narrative synthesis (see Methods) rather than a formal year-over-year temporal trend quantification. Globally, five species predominate, namely Candida albicans, C. parapsilosis sensu lato (s.I.), Candida tropicalis, Nakaseomyces glabratus, and Pichia kudriavzevii, with a sustained increase in non-albicans species and growing resistance to fluconazole. In Latin America, the burden varies depending on the hospital setting; C. parapsilosis sensu lato (s.I.) predominates in NICUs, and Candidozyma auris has emerged, associated with nosocomial outbreaks and multidrug resistance. Factors such as extreme prematurity, prolonged catheter use, parenteral nutrition, and antibiotics are consistently associated with the risk of infection. Mortality remains high, influenced by diagnostic delays and species characteristics. Standardized microbiological surveillance, accurate identification, and strategies tailored to each clinical setting are required to improve outcomes in this vulnerable population.