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Invasive Candida parapsilosis Bloodstream Infections in Children: The Antifungal Susceptibility, Clinical
Yao-Sheng Wang1,2, Jen-Fu Hsu1,3, Wei-Ju Lee1,2
1College of Medicine, Chang Gung University, Taoyuan 244, Taiwan.
Abstract:
Background: Candida parapsilosis is the most common non-albicans candida species that causes invasive candidiasis, but little is known about its impacts on the outcomes of pediatric patients. We aimed to characterize the clinical characteristics, risk factors and outcomes of C. parapsilosis bloodstream infections (BSIs) in children. Methods: All pediatric patients with Candida parapsilosis BSIs between 2005 and 2020 from a medical center in Taiwan were enrolled and analyzed. The antifungal susceptibility, clinical manifestations, management and outcomes were investigated. Cases of Candida parapsilosis BSIs were compared between patients with C. albicans BSIs and other Candida spp. BSIs. Results: During the study period, 95 episodes (26.0% of total cases) of Candida parapsilosis BSIs were identified and analyzed. No significant difference was found between pediatric patients with C. parapsilosis BSIs and those with C. albicans BSIs in terms of patients' demographics, most chronic comorbidities or risk factors. Pediatric patients with C. parapsilosis BSIs were significantly more likely to have previous azole exposure and be on total parenteral nutrition than those with C. albicans BSIs (17.9 vs. 7.6% and 76.8 vs. 63.7%, p = 0.015 and 0.029, respectively). The duration of C. parapsilosis candidemia was relatively longer, and therefore patients often required a longer duration of antifungal treatment when compared with those of C. albicans candidemia, although the candidemia-attributable mortality rates were comparable. Of the C. parapsilosis isolates, 93.7% were susceptible to all antifungal agents, and delayed appropriate antifungal treatment was an independent factor in treatment failure. Conclusions: Pediatric patients with C. parapsilosis BSIs were more likely to have previous azole exposure and be on total parenteral nutrition, and the clinical significances included a longer duration of candidemia and patients often required a longer duration of antifungal treatment.
Insights
Pediatric bloodstream infections caused by Candida parapsilosis are linked to prior azole exposure and total parenteral nutrition. These infections require longer antifungal treatment but have similar mortality rates compared to Candida albicans.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Mycology
Background:
- Candida parapsilosis is a common non-albicans Candida species causing invasive candidiasis.
- Limited data exists on the specific impact of C. parapsilosis on pediatric patient outcomes.
- Understanding risk factors and clinical characteristics is crucial for effective management.
Purpose of the Study:
- To characterize clinical features, risk factors, and outcomes of C. parapsilosis bloodstream infections (BSIs) in children.
- To compare C. parapsilosis BSIs with those caused by C. albicans and other Candida species.
- To identify factors influencing treatment success and patient prognosis.
Main Methods:
- Retrospective analysis of pediatric patients with C. parapsilosis BSIs from 2005-2020.
- Investigation of antifungal susceptibility, clinical manifestations, management strategies, and patient outcomes.
- Comparative analysis between C. parapsilosis BSIs and BSIs caused by C. albicans and other Candida species.
Main Results:
- 95 episodes of C. parapsilosis BSIs were identified, representing 26.0% of total Candida BSIs.
- Patients with C. parapsilosis BSIs showed higher rates of prior azole exposure and total parenteral nutrition compared to C. albicans BSIs.
- C. parapsilosis candidemia duration was longer, necessitating extended antifungal treatment, though mortality rates were comparable.
- 93.7% of C. parapsilosis isolates were susceptible to all tested antifungal agents.
- Delayed appropriate antifungal treatment was an independent predictor of treatment failure.
Conclusions:
- Pediatric C. parapsilosis BSIs are associated with specific risk factors including azole exposure and total parenteral nutrition.
- Clinical significance includes prolonged candidemia and extended antifungal treatment requirements.
- Prompt and appropriate antifungal therapy is critical for successful treatment outcomes in pediatric candidemia.
