Epidemiology of Culture-confirmed Candidemia Among Hospitalized Children in South Africa, 2012–2017

Abstract

Background:We aimed to describe the epidemiology of candidemia among children in South Africa. Methods: We conducted laboratory-based surveillance among neonates (≤28 days), infants (29 days to <1 year), children (1-11 years) and adolescents (12-17 years) with Candida species cultured from blood during 2012-2017. Identification and antifungal susceptibility of viable isolates were performed at a reference laboratory. We used multivariable logistic regression to determine the association between Candida parapsilosis candidemia and 30-day mortality among neonates. Results: Of 2996 cases, neonates accounted for 49% (n = 1478), infants for 27% (n = 806), children for 20% (n = 589) and adolescents for 4% (n = 123). The incidence risk at tertiary public sector hospitals was 5.3 cases per 1000 pediatric admissions (range 0.39-119.1). Among 2943 cases with single-species infections, C. parapsilosis (42%) and Candida albicans (36%) were most common. Candida auris was among the 5 common species with an overall prevalence of 3% (n = 47). Fluconazole resistance was more common among C. parapsilosis (55% [724/1324]) versus other species (19% [334/1737]) (P < 0.001). Of those with known treatment (n = 1666), 35% received amphotericin B deoxycholate alone, 32% fluconazole alone and 30% amphotericin B deoxycholate with fluconazole. The overall 30-day in-hospital mortality was 38% (n = 586) and was highest among neonates (43% [323/752]) and adolescents (43% [28/65]). Compared with infection with other species, C. parapsilosis infection was associated with a reduced mortality among neonates (adjusted odds ratio 0.41, 95% confidence interval: 0.22-0.75, P = 0.004). Conclusions: Candidemia in this setting mainly affected neonates and infants and was characterized by fluconazole-resistant C. parapsilosis with no increased risk of death.

A Brazilian Inter-Hospital Candidemia Outbreak Caused by Fluconazole-Resistant Candida parapsilosis in the COVID-19 Era

“…Although the global FLC resistance rates in C. parapsilosis range between 2 and 5% [8], much higher rates (15.1-90%) have been recently reported in some countries from Europe, Asia, Africa, and Latin America [18,[35][36][37]. Molecular mechanisms combinations, including the overexpression of efflux pumps and point mutations in ERG11 gene, may be involved in C. parapsilosis FLC resistance [24].…”

Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year Survey

“…A short time ago, FLC resistance was considered to be uncommon among C. parapsilosis SC strains. While the phenomenon had appeared to be restricted to certain geographic regions, an ever-growing number of FLC-resistant clinical isolates have been reported worldwide from Brazil [57,83,84], France [85], India [86], Korea [87,88], Kuwait [32], North America [82], and South Africa [56,89], whilst the problem is already broadly disseminated in Italy [48,82,90] and Turkey [91][92][93]. FLC resistance C. parapsilosis SC has been well associated with selective drug pressure attributable to the extensive use of FLC as prophylaxis and treatment or even to exposure to systemic antimicrobials [94,95] with subsequent patient-to-patient spread in an epidemic way with clonal transmission and establishment of persistent resistant isolates within the hospital environment [83][84][85]92].…”

Incidence of candidemia and prevalence of azole-resistant candidemia at a tertiary South African hospital – A retrospective laboratory analysis 2016–2020

“… 3 Population-specific incidences from South Africa include reported incidences of 2.8 per 10 000 adult admissions from a study conducted in 1990–2007 to 5.3 cases per 1000 paediatric admissions at tertiary hospitals. 8 , 9 However, as a result of non-standardised reporting of incidence, no meaningful assessments can be made.…”