Evaluation of Candidemia Due to Uncommon Candida Species in Children: A Multicenter Retrospective Study

Candidemia is a life-threatening infection, and uncommon Candida species (UCS) are increasingly reported in pediatric patients. We aimed to evaluate the demographic and clinical characteristics of UCS candidemia in children.

This multicenter retrospective study included pediatric patients with UCS candidemia (species other than Candida albicans , Candida parapsilosis , Candida glabrata , Candida tropicalis and Candida krusei ) from 14 tertiary hospitals in Turkey between January 2013 and December 2023.

A total of 221 episodes in 204 patients were analyzed. The median age was 29 months (interquartile range [IQR]: 7.8-78.5), and 58.8% were male. The most common UCS were Candida lusitaniae (n = 44, 19.9%), Candida kefyr (n = 40, 18.1%) and Candida guilliermondii (n = 31, 14%). Hematologic malignancy was the most frequent underlying condition (n = 50, 22.6%). Central venous catheters (CVC) were present in 76% (n = 168) of patients and were removed in 67.9% (n = 114) of episodes. Immunosuppressive therapy and recent surgery were documented in 53.8% (n = 119) and 53.4% (n = 118) of episodes, respectively, while total parenteral nutrition was used in 44.3% (n = 98). Recent antibiotic exposure was observed in 95.5% (n = 211) of episodes, and concomitant bacteremia occurred in 27.1% (n = 60). Neutropenia and thrombocytopenia were present in 59.7% (n = 132) and 48% (n = 106) of episodes, respectively. Antifungal prophylaxis was recorded in 23.5% (n = 52) of episodes, predominantly with fluconazole (76.9%). Susceptibility rates were 89.2% (116/130) for fluconazole, 90.4% (113/125) for caspofungin and 85.7% (102/119) for amphotericin B. Pediatric intensive care unit admission was required in 25.8% (n = 57) of episodes. The 7-day and 30-day mortality rates were 7.2% (n = 16) and 14.5% (n = 32), respectively. Female sex and longer hospital stay before infection were associated with increased mortality (7-day: P = 0.04 and P = 0.047; 30-day: P = 0.02 and P = 0.023). Mechanical ventilation, urinary catheterization and total parenteral nutrition were more frequent among nonsurvivors in both mortality periods (7-day: P < 0.001, P = 0.03, P < 0.001; 30-day: P < 0.001, P < 0.001, P = 0.03). The CVC removal rate was lower in mortality groups than in survivors (7-day: P = 0.005 and 30-day: P = 0.006).Thrombocytopenia was associated with both 7-day and 30-day mortality ( P < 0.001 and P = 0.001), while elevated C-reactive protein levels were associated with 7-day mortality ( P = 0.046).

UCS candidemia in children most commonly occurred in patients with solid-hematologic malignancy, central venous catheters and recent antibiotic exposure within 1 week. Female sex, prolonged pre-infection hospitalization, intensive care-related interventions, thrombocytopenia, lower CVC removal rate and elevated C-reactive protein were associated with increased short-term mortality.