Evaluation of candidemia in children at a university hospital: A retrospective cohort

BackgroundCandidemia is a life-threatening infection in hospitalied children. This study aimed to evaluate candidemia's demographic and clinical characteristics and identify the risk factors and outcomes of Candida albicans (CA) and non-albicans Candida (NAC) spp. MethodsA retrospective cohort was designed to evaluate paediatric patients with candidemia between January 2008 and December 2020. ResultsA total of 342 episodes in 311 patients were evaluated. The median age of the patients was 2.1 years (1 month-17 years and 6 months), and 59.6% were male. The prevalence of NAC (67.5%) candidemia was higher than that of CA (32.5%). The most commonly isolated Candida species was Candida parapsilosis (43.3%), followed by C. albicans (32.5%), Candida glabrata (6.1%) and Candida tropicalis (5.0%). The length of hospital stay prior to the positive culture and the total length of hospital stay were longer in the NAC group (p = .003 and p = .006). The neutrophil count was lower in the NAC group (p = .007). In the multivariate analysis, total parenteral nutrition, antifungal prophylaxis and a history of coagulase-negative staphylococci (CoNS) culture positivity in the past month were risk factors for developing candidemia due to NAC (p values were .003, .003 and .045). C. albicans and C. parapsilosis fluconazole resistance were 9.5% and 46.6%, respectively. The rates of amphotericin B resistance were 1.1% and 7.6% in C. albicans and C. parapsilosis, respectively. Mortality (14-day and 30-day) rates did not differ between the groups. ConclusionsA history of CoNS culture positivity in the past month, total parenteral nutrition, and antifungal prophylaxis increases the risk of NAC candidemia.

Automated summary

This study evaluated the demographic and clinical characteristics of candidemia in hospitalized children and identified risk factors and outcomes for Candida albicans and non-albicans Candida spp. The prevalence of non-albicans Candida candidemia was higher than that of Candida albicans. Total parenteral nutrition, antifungal prophylaxis, and a history of coagulase-negative staphylococci culture positivity were identified as risk factors for non-albicans Candida candidemia. The rates of fluconazole and amphotericin B resistance in Candida species were also determined.