{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:15:52Z","timestamp":1791490552999,"version":"4.3.4"},"reference-count":59,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013543","name":"ESPID","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013543","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Society of Paediatric Infectious Diseases"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Invasive Candida infection remains a significant threat to neonates worldwide. Most evidence on neonatal invasive candidiasis (NIC) comes from high-income countries, leaving the burden and characteristics of NIC in low- and middle-income countries (LMICs) poorly described. This study aimed to investigate the incidence, case-fatality rates (CFR), epidemiology, and etiology of NIC in LMICs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a systematic literature review and meta-analyses of all eligible studies in 17 databases published from inception until April 2022 focusing on microbiologically confirmed NIC in LMICs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>A total of 257 articles were included, with 10 994 NIC cases from 27 LMICs. The overall incidence rate was 2.6% (95% confidence interval [CI], 2.2\u20133.0). Regional disparities were evident, with South-East Asia reporting the highest incidence rate (6.3%; 95% CI, 3.2\u201310.3). The mean gestational age and birth weight were 31.4 weeks (standard deviation, 3.3) and 1530\u2005g (standard deviation, 644.6), respectively. Among 10 087 included isolates, the predominant species was C albicans (39.0%), followed by C parapsilosis (24.8%), with marked differences in species distribution across World Health Organization regions. Fluconazole was the most commonly used agent for NIC treatment (55.4%; 1567\/2826). Overall, 24.8% (1128\/6613) of isolates with available data were resistant to fluconazole. The pooled estimated CFR was 18.7% (95% CI, 15.5\u201322.1).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A higher NIC incidence rate and CFR in LMICs is noted compared to high-income countries, although infected babies were less premature with a higher birth weight. The proportion of fluconazole-resistant isolates was high. Prevention and treatment strategies for NIC need to be targeted to LMIC settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf329","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T16:28:16Z","timestamp":1749659296000},"source":"Crossref","is-referenced-by-count":8,"title":["The Burden of Neonatal Invasive Candidiasis in Low- and Middle-income Countries: A Systematic Review and Meta-analysis"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2841-0338","authenticated-orcid":false,"given":"Daniel Hsiang-Te","family":"Tsai","sequence":"first","affiliation":[{"name":"Centre for Neonatal and Paediatric Infection, City St. George's, University of London , London ,","place":["UK"]},{"name":"School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University , Tainan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4248-4594","authenticated-orcid":false,"given":"Ian Chang-Yen","family":"Wu","sequence":"additional","affiliation":[{"name":"Centre for Neonatal and Paediatric Infection, City St. George's, University of London , London ,","place":["UK"]},{"name":"School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University , Tainan ,","place":["Taiwan"]},{"name":"Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling-Fang","family":"Chang","sequence":"additional","affiliation":[{"name":"Institute of Public Health, School of Medicine, National Yang-Ming Chiao Tung University , Taipei ,","place":["Taiwan"]},{"name":"Department of Pharmacy, Taipei Veterans General Hospital , Taipei ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2120-683X","authenticated-orcid":false,"given":"Marie Jen-Huey","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Colleage of Pharmaceutical Sciences, National Yang Ming Chiao Tung University , Taipei ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brishti","family":"Debnath","sequence":"additional","affiliation":[{"name":"Centre for Neonatal and Paediatric Infection, City St. George's, University of London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7869-9462","authenticated-orcid":false,"given":"Nelesh P","family":"Govender","sequence":"additional","affiliation":[{"name":"Wits Mycology Division, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]},{"name":"Institute for Infection and Immunity, City St. George's, University of London , London ,","place":["UK"]},{"name":"Medical Research Council Centre for Medical Mycology, University of Exeter , Exeter ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8626-8291","authenticated-orcid":false,"given":"Mike","family":"Sharland","sequence":"additional","affiliation":[{"name":"Centre for Neonatal and Paediatric Infection, City St. George's, University of London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6586-3358","authenticated-orcid":false,"given":"Adilia","family":"Warris","sequence":"additional","affiliation":[{"name":"Medical Research Council Centre for Medical Mycology, University of Exeter , Exeter ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7955-852X","authenticated-orcid":false,"given":"Yingfen","family":"Hsia","sequence":"additional","affiliation":[{"name":"Centre for Neonatal and Paediatric Infection, City St. George's, University of London , London ,","place":["UK"]},{"name":"Acute Respiratory Unit, UK Health Security Agency , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2871-1747","authenticated-orcid":false,"given":"Laura","family":"Ferreras-Antolin","sequence":"additional","affiliation":[{"name":"Centre for Neonatal and Paediatric Infection, City St. George's, University of London , London ,","place":["UK"]},{"name":"Medical Research Council Centre for Medical Mycology, University of Exeter , Exeter 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