CAN-ANDA: Multicenter Study of Invasive Candidiasis in Children and Neonates in Andalusia, Spain

Candidemia is a leading cause of invasive fungal infections, with an increased incidence of non-Candida species and resistance. However, pediatric epidemiologic data remain limited.

Multicenter retrospective study analyzing epidemiologic and clinical variables in neonates and children (≤14 years) with candidemia identified by positive blood cultures across 6 tertiary hospitals in southern Spain (2010-2020).

A total of 286 cases were identified. Sixty-one percent of patients were admitted to intensive care units. The incidence rates in the neonatal and pediatric intensive care units were 3.2/1000 and 2.5/1000 admissions, respectively. Prematurity was the most common underlying condition (29.4%), followed by onco-hematologic conditions (20.6%) and congenital heart diseases (15%), with 81% of them infected during the perioperative cardiac surgery. Candida parapsilosis was the most prevalent species (46.5%), with fluconazole resistance <1% but echinocandin resistance 8.4-28.6%. Candida albicans (33.6%) remained highly susceptible to all antifungals. Ninety-five percent of the Candida species were susceptible to fluconazole. Empirical treatment included liposomal amphotericin B (57.6%), fluconazole (30.3%) and echinocandins (7.4%), and targeted therapy with fluconazole was prescribed in only 30% of the cases. Recurrence occurred in 17.2% of cases, more frequently with C. parapsilosis ( P = 0.025), parenteral nutrition ( P = 0.004) and congenital heart disease ( P < 0.001). Mortality was 22.3%, associated with recurrent candidemia ( P = 0.009), thrombocytopenia ( P = 0.037) and absence of antifungal prophylaxis ( P = 0.035).

High incidence of C. parapsilosis with the greatest recurrence risk was observed in Southern Spain, with a high overall mortality. Low fluconazole resistance supports the need to optimize targeted therapy and enhance the importance of antimicrobial stewardship programs.