Candida auris in a Tertiary Neonatal Intensive Care Unit: A Retrospective Descriptive Study of Clinical and Infection-Control Management

Candida auris represents a growing challenge in neonatal intensive care units (NICUs), where extreme prematurity, invasive support, diagnostic uncertainty, and environmental persistence complicate both clinical management and infection prevention. We describe a retrospective, single-center experience in a tertiary NICU in Bucharest, Romania, from January 2023 to August 2026, focusing on the clinical and epidemiological lessons learned during recurrent C. auris detections. The study included 33 infants with C. auris recovered from diagnostic clinical specimens, comprising 26 with blood-culture-confirmed candidemia and seven with non-candidemic detections managed as suspected infections. An additional 21 colonized-only infants were described separately. Clinical manifestations were nonspecific, while thrombocytopenia was documented in 24/26 infants with candidemia (92.3%). Documented bloodstream clearance occurred in 23/26 infants (88.5%), and all-cause mortality was 23.1% (6/26) in confirmed candidemia and 21.2% (7/33) in the overall clinical series. Antifungal management evolved according to drug availability and clinical response, with susceptibility testing available for only a subset of patients. Surveillance expanded from contact-based screening to weekly unit-wide screening, alongside progressively implemented, overlapping infection-prevention measures. This experience highlights the importance of accurate microbiological classification, individualized antifungal management, and sustained surveillance in high-risk neonatal populations. Rather than demonstrating the effectiveness of individual interventions, it illustrates how clinical and infection-control practices evolve through recognition, adaptation, and progressive institutional preparedness.