Malassezia species grown in the skin flora of newborns treated in the neonatal intensive care unit and affecting factors

Malassezia yeasts are lipophilic, lipid-dependent, lipophilic commensal yeast fungi found in the normal skin flora of both adults and newborns. They cause opportunistic infections in both adults and newborns. The neonatal period is the 28-day period after birth. During this period, newborns have high Malassezia colonization for many different reasons. In our study, Malassezia colonization was investigated in newborns in the neonatal intensive care unit. Our study was conducted on 150 newborns followed up in the Neonatal Intensive Care Unit of Pamukkale University Hospital between January 1, 2021 and January 1, 2022. Samples were taken from newborns within 24-48 hours after their admission to the Neonatal Intensive Care Unit. Skin swabs were taken from the forehead, cheeks and breasts of 150 newborns with sterile cotton swabs. Neonates with skin infections and open wounds on the skin were not included in the study. The sex, weight at the time of sampling, age at the time of sampling (in days), whether the newborns were receiving total parenteral nutrition at the time of sampling, whether the newborns were receiving fluconazole prophylaxis at the time of sampling, and mode of delivery were noted. The samples were sown on mDixon agar medium and incubated in a humid oven at 32C for two weeks. After the colonies were confirmed as yeast by native microcopic examination, they were inoculated on Sabouraud's dextrose agar (SDA) medium. The samples incubated under the same conditions for one week were typed by tween assimilations (10% Tween 20, 0.5% Tween 40, 0.5% Tween 60, 0.1% Tween 80) following the absence of growth on SDA medium. Of the 50 newborns sampled, both forehead, cheek and chest samples grew. There was no growth in the forehead, cheek and chest of 100 newborns sampled. The same species of Malassezia was isolated from all 3 body parts of the newborns with Malassezia growth. In 50 newborns with Malassezia growth, 16 (32%) Malassezia furfur, 13 (26%) Malassezia sympodialis, 9 (18%) Malassezia restricta, 6 (12%) Malassezia obtusa and 6 (12%) Malassezia globosa were isolated. Colonization was found in 50 (33.3%) of 150 newborns. Of the 150 newborns sampled, 30 (20%) were receiving fluconazole prophylaxis and 120 (80%) were not receiving fluconazole prophylaxis. Malassezia grew in 3 (10%) of 30 newborns receiving fluconazole prophylaxis. Of 120 newborns who did not receive fluconazole prophylaxis, 47 (39.1%) grew Malassezia. As a result of our study, fluconazole prophylaxis and age at sampling were statistically significant in neonatal colonization (p<0.05). Colonization rate was found to be low in newborns receiving fluconazole prophylaxis. Colonization rate was found to be high in newborns who were older at the time of sample collection. Gender of the newborn, weight at the time of sampling, whether the newborn was receiving total parenteral nutrition at the time of sampling, and mode of delivery were not statistically significant in terms of colonization (p>0.05). Fluconazole prophylaxis was found to be protective against Malassezia colonization in newborns. It was also found that skin colonization of newborns increased with age.