The accuracy of the Candida Score® in predicting the likelihood of fungal sepsis in newborns

Background: Candidemia poses a significant health challenge in neonates. This study evaluates a modified version of the Candida Score to enhance early detection and guide antifungal therapy decisions. Objective: To assess the accuracy of a revised Candida Score^® that integrates thrombocytopenia and patient origin into the original parameters. Methods: A retrospective case-control study was conducted at the Harapan Kita National Women and Children Health Centre (HKNWCHC) from 2017 to 2023. The study involved 32 neonates diagnosed with candidemia and 29 with bacterial sepsis. The original Candida Scorecomprising total parenteral nutrition (TPN), surgery, multifocal colonisation, and severe sepsis was modified by adding platelet count and patient origin. Multivariate logistic regression identified predictive factors, while ROC curve analysis validated the revised scoring system. Results: Severe thrombocytopenia (AOR 7.153; p = 0.043) and outborn status (AOR 6.035; p = 0.014) were significantly associated with candidemia. The revised Candida Score^® showed sensitivity of 81.3, specificity of 58.6, positive predictive value (PPV) of 68.4, negative predictive value (NPV) of 62.9, and an area under the curve (AUC) of 0.743 (p = 0.001). Conclusion: Incorporating outborn status and thrombocytopenia improved early identification of neonatal candidemia. The revised Candida Score^® is a practical tool for empirical antifungal guidance in resource-limited settings. Its high sensitivity makes it an effective screening tool, despite moderate specificity. © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.