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Published on: July 1, 2020
Epidemiology of Candidemia in Children and Neonates in Korea, 2009-2018: A Multi-Center Study
Joon-Sik Choi1, Sae Rom Choi2, Soo-Han Choi3
1Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea.
Insights
Invasive candidal infections, or candidemia, are a significant threat in pediatric populations. This study found non-albicans Candida species were more prevalent, with noted antifungal resistance, highlighting the need for ongoing surveillance.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Epidemiology
Background:
- Invasive candidal infections pose a serious health risk to high-risk pediatric patients.
- Limited data exists on the epidemiology of candidemia in Korean pediatric populations.
Purpose of the Study:
- To investigate the epidemiology and outcomes of candidemia in Korean pediatric patients.
- To identify common Candida species and assess antifungal susceptibility.
Main Methods:
- Retrospective chart review of patients aged 0-18 years diagnosed with candidemia between 2009 and 2018.
- Patients were categorized into neonatal and pediatric groups.
- Analysis included Candida species, antifungal sensitivity, underlying conditions, and outcomes.
Main Results:
- Non-albicans Candida species (65.4%) were more common than Candida albicans.
- Candida parapsilosis was the most frequent species overall and in neonates; C. albicans was most common in pediatric patients.
- 11.2% of isolates showed intermediate or resistant to fluconazole, with higher rates in non-albicans species. Overall 30-day mortality was 25.4%.
Conclusions:
- Non-albicans Candida species predominated in pediatric candidemia during the study period.
- Antifungal resistance was observed, necessitating careful monitoring.
- Epidemiological surveillance for candidemia in pediatric populations is crucial.
Background:
Invasive candidal infection is a serious health threat to high-risk pediatric populations. Data on pediatric epidemiology of candidemia in Korea are limited.
Methods:
A retrospective chart review was performed for patients aged 0-18 years who were diagnosed with candidemia from 2009 to 2018 in tertiary hospitals. Patients were divided into two groups; a neonatal group of babies with postnatal age 28 days or younger or any patients hospitalized in neonatal intensive care unit and a pediatric group of the rest of patients. Only the first candidemia episode for each patient was included. Candida species, antifungal sensitivity, underlying condition, and outcomes were investigated.
Results:
A total of 228 patients with candidemia were identified from five hospitals. Of them, 87 and 141 were assigned into the neonatal group and the pediatric group, respectively. The most common underlying condition was prematurity (88.5%) in the neonatal group and hematology-oncology diseases (49.6%) in the pediatric group. Non- albicans Candida spp. (65.4%) was more common than C. albicans. C. parapsilosis was the most commonly identified species (35.1%), followed by C. albicans (34.6%), C. tropicalis (9.6%), C. glabrata (9.6%), and C. krusei (2.2%) in all patients. C. parapsilosis was the most common pathogen in the neonatal group, while C. albicans was the most common pathogen in the pediatric group. Results of antifungal sensitivity to fluconazole were available for 160 patients. About 11.2% of isolates were either intermediate or resistant to fluconazole (10.0% for non-albicans, 1.2% for C. albicans) (P = 0.036). Overall mortality within 30 days after candidemia was 25.4%.
Conclusion:
Candidemia caused by non-albicans Candida was more common in pediatric patients during the study period. Resistance to antifungal agents was noted. Monitoring for epidemiologic change is warranted.
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