Evaluation of sepsis screening and matrix-assisted laser desorption ionisation-time of flight mass spectrometry for the diagnosis of neonatal candidaemia in a Sub-Himalayan tertiary centre in India

Neonatal candidaemia is a significant cause of morbidity and mortality in neonatal intensive care settings, particularly in low- and middle-income countries where diagnostic delays remain a challenge. The diagnostic utility of a five-parameter sepsis screen and the comparison of matrix-assisted laser desorption ionisation-time of flight mass spectrometry (MALDI-TOF MS) with VITEK-2 for identification of Candida species in neonates were evaluated at a tertiary care institute in the sub-Himalayan region of India from November 2022 to March 2024. Non-albicans Candida species accounted for 75% of isolates. Significant discordance was observed between MALDI-TOF MS and VITEK-2, particularly for cryptic species. The sepsis screen demonstrated a sensitivity of 77.8% but lacked specificity because it included only culture-positive fungal cases. The mortality rate was 30%. Thus, we conclude that a sepsis screen serves as a useful early screening tool but is non-specific. MALDI-TOF MS provides more accurate and faster species identification than biochemical methods. A combined diagnostic approach may help reduce delays in targeted therapy in neonatal candidemia.