Invasive Candida Infections in Children: Species Distribution, Antifungal Susceptibility, and Risk Factors Associated with Mortality

Year 2023, Volume: 24 Issue: 1, 78 - 84, 30.03.2023

Zeynep Güleç Köksal Nurşen Belet , Mahmut Cem Ergon Ahmet Naci Emecen , Mine Doluca Dereli

https://doi.org/10.4274/meandros.galenos.2023.05925

Abstract

Objective: This study determined the distribution and antifungal susceptibility of Candida species, risk factors, and mortality in invasive candidiasis (IC).
Materials and Methods: The medical data of the pediatric patients with IC were analyzed retrospectively between September 2014 and September 2018. The first IC episodes were included, and the susceptibility was determined by the microdilution method performed according to The Clinical and Laboratory Standards Institute M27-A3 standards. Kaplan-Meier curves were prepared for survival on the 7th and 30th day after the first positive culture and the curves were compared with the log-rank test.
Results: Forty-eight Candida isolates were detected in 45 IC episodes. C. albicans and C. parapsilosis were the most common species (both 41.7%). Fluconazole, caspofungin, and amphotericin B resistance were 38.2%, 3.1%, and 2.9%, respectively. Fluconazole resistance was 73.3% among C. parapsilosis. The most common risk factors were underlying diseases (100%), previous antibiotic use (95.6%), and central venous catheter (73.3%). Six (13.3%) patients were deceased within the 30 days. Patients with neutropenia and dialysis had a higher rate of mortality and lower mean survival times for 7-day and 30-day mortality. Mean survival times for 7-day mortality were lower for the patients who had abdominal surgery (p=0.04).
Conclusions: There was high fluconazole resistance in C. parapsilosis, which was 73.3%. Neutropenia, dialysis, and abdominal surgery were associated with a significant increase in mortality. These data will help us identify patients who are at risk for IC and will guide us in the selection of empirical treatment.

Keywords

Antifungal susceptibility , amphotericin B , candidaemia , Candida spp. , fluconazole resistance , pediatric

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