Trends in Pediatric Invasive Candidiasis: Shifting Species Distribution and Improving Outcomes

Invasive candidiasis is a major contributor to morbidity and mortality in hospitalized children, particularly in those with comorbidities or prolonged hospitalizations. This study evaluated the epidemiology, antifungal susceptibility, and outcomes of invasive Candida infections over an 11-year period.

A retrospective study was conducted at Hacettepe University Children's Hospital from 2013 to 2024. Pediatric patients with culture-confirmed invasive Candida infections were included. Data on species distribution, antifungal susceptibility, and clinical outcomes were analyzed.

A total of 158 invasive candidiasis episodes were identified, yielding 166 Candida isolates. Candida albicans was most common (40.3%), followed by Candida parapsilosis SC (24.1%), Nakaseomyces glabratus (7.8%), Candida tropicalis (7.8%), Clavispora lusitaniae (7.2%), and others (12%). Candidemia accounted for 89.9% of cases; less common manifestations included meningitis, peritonitis, endocarditis, and pneumonia. Over time, C. albicans cases declined, while C. parapsilosis SC remained the predominant non-albicans species. Fluconazole resistance was highest in C. parapsilosis SC (13.2%). Overall mortality was 35.4%, with 14.6% directly attributed to invasive candidiasis. Catheter removal significantly reduced mortality (OR = 8.44, 95% CI: 2.81-25.3, p < 0.001).

Non-albicans Candida species became increasingly prevalent, while C. albicans declined. Mortality significantly decreased, likely due to improved patient management. Rising azole resistance in C. parapsilosis SC and the benefit of early catheter removal highlight the need for timely, species-specific strategies.