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High co-infection burden and ICU-specific pathogen profiles in pediatric Candida albicans respiratory infections: a
Ya Huang1, Huideng Zhou2, Jiangyang Zhao2
1Department of Pediatric Respiratory Medicine, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China.
Insights
Candida albicans is a common cause of respiratory infections in hospitalized children, often co-infecting with other pathogens. Early detection and tailored treatments are crucial for improving outcomes and reducing complications.
Area of Science:
- Medical Microbiology
- Pediatric Infectious Diseases
- Diagnostic Technologies
Background:
- Candida albicans is an opportunistic pathogen causing significant pediatric respiratory infections.
- Systematic analyses of C. albicans in hospitalized children are limited.
- This study investigates the prevalence, clinical features, and outcomes of C. albicans-associated respiratory infections in pediatric inpatients.
Purpose of the Study:
- To determine the prevalence of Candida albicans in pediatric respiratory infections.
- To characterize the clinical profiles and outcomes of these infections.
- To identify risk factors and co-infections associated with C. albicans in hospitalized children.
Main Methods:
- A cohort of 10,310 pediatric inpatients with respiratory infections was screened.
- Pathogen detection was performed using targeted next-generation sequencing (tNGS).
- Data collected included pathogen identification, clinical characteristics, and patient outcomes.
Main Results:
- Candida albicans was detected in 5.0% of pediatric respiratory infections.
- Co-infections were highly prevalent (99.0%), with common pathogens including Mycoplasma pneumoniae, Haemophilus influenzae, and Rhinovirus.
- Intensive Care Unit (ICU) patients exhibited distinct pathogen profiles (e.g., Acinetobacter baumannii) and poorer outcomes, including prolonged hospitalization and increased inflammatory markers.
Conclusions:
- Targeted next-generation sequencing (tNGS) is effective for identifying C. albicans and co-infections in pediatric respiratory infections.
- Lower respiratory tract specimens (sputum, BALF) show higher C. albicans positivity, suggesting specimen-selective diagnostics.
- Optimized tNGS protocols and ICU-tailored antimicrobial strategies are recommended to reduce morbidity and socioeconomic burdens.
Background:
Candida albicans is a significant opportunistic pathogen in pediatric respiratory infections, yet systematic analyses of its role in hospitalized children remain scarce. This study evaluates the prevalence, clinical profiles, and outcomes of C. albicans-associated respiratory infections in this population.
Methods:
From April 2021 to December 2024, 10,310 pediatric inpatients with respiratory infections at Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital underwent pathogen screening via targeted next-generation sequencing (tNGS).
Results:
C. albicans was detected in 5.0% (511/10,310), with detection rates varying by specimen: highest in sputum (10.3%), followed by bronchoalveolar lavage fluid (8.8%), and minimal in throat swabs (0.3%). Co-infections occurred in 99.0% (506/511), predominantly involving Mycoplasma pneumoniae (189), Haemophilus influenzae (174), and Rhinovirus (169). ICU patients (6.3%) demonstrated elevated inflammatory markers (PCT: 0.31 vs. 0.08 ng/mL; D-dimer: 795 vs. 360 ng/mL FEU; P < 0.001), prolonged hospitalization (median 17 vs. 7 days, P < 0.001), and distinct pathogens (Acinetobacter baumannii vs. M. pneumoniae in non-ICU). 51.7% and 35.4% of the children experienced respiratory and other systemic complications, respectively. Among the 511 children diagnosed with C. albicans infection, 32 (6.3%) required ICU admission for monitoring. The median duration of hospitalization for these 511 children was 7 days. Of these, 482 (94.3%) recovered and were discharged following treatment, while 26 (5.0%) had family members who requested voluntary discharge due to unsatisfactory outcomes or other reasons. Unfortunately, 3 children (0.6%) died despite receiving intensive medical treatment.
Conclusion:
This large-scale tNGS-based study addresses critical knowledge gaps, revealing ICU-specific pathogen profiles (A. baumannii), high co-infection burdens (99.0%), and complications linked to prematurity/immunodeficiency. The predominance of lower respiratory tract involvement (sputum/BALF positivity) underscores the need for specimen-selective diagnostics. Findings advocate for optimized tNGS protocols, ICU-tailored antimicrobial strategies, and early interventions in high-risk subgroups to reduce morbidity (e.g., sepsis risk) and socioeconomic burdens.
