Epidemiology, Species Susceptibility, and Mortality Risk Factors of Pediatric Candidemia: A 13-Year Multicenter Study

Candida species are the leading cause of invasive fungal infections in children and are associated with substantial morbidity and mortality. We conducted a multicenter retrospective study across nine hospitals in Israel, including all candidemia episodes in patients aged 0-18 years between 2010 and 2022. Clinical, microbiological, and outcome data were collected, and multivariable logistic regression was used to identify predictors of 30-day mortality. A total of 498 candidemia episodes were identified in 482 patients. Most episodes occurred in immunocompromised children or those admitted to intensive care units. Non-albicans Candida species predominated (63.3%), although C. albicans remained the single most common species (36.7%). The most frequent non-albicans species were C. parapsilosis (25.5%), C. tropicalis (15.9%), and C. glabrata (9.6%). No cases of C. auris were identified. Fluconazole non-susceptibility was observed in 19.4% of isolates and increased from 15.5% during 2010-2016 to 23.3% during 2017-2022 (OR 2.89, 95% CI 1.45-5.11, p = 0.007). The 30-day mortality rate was 23.4%. Independent predictors of mortality included liver disease, neutropenia, total parenteral nutrition, urinary tract infection, skin lesions, and peritonitis. Pediatric candidemia remains associated with considerable mortality, while increasing fluconazole non-susceptibility among non-albicans Candida species highlights the need for ongoing surveillance and antifungal stewardship.