Candidemia due to uncommon Candida species in children: new threat and impacts on outcomes

Abstract

Many uncommon Candida spp. (species other than C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, and C. krusei) have been shown to emerge in tertiary care facilities. We aimed to investigate these uncommon candidemia in children. Forty-six cases of candidemia caused by uncommon Candida spp. were identified during 2003–2015 from a medical center in Taiwan. The most common specie was C. guilliermondii (31.2%), followed by C. lusitaniae (18.8%) and C. metapsilosis (18.8%). These cases were analyzed and compared with 148 episodes of C. albicans candidemia. The incidence density of uncommon Candida spp. candidemia and the proportion to all candidemia episodes increased substantively during the study period. Prior exposure to azoles was uncommon in the 30 days prior to infection, but fluconazole resistant strains were significantly more common (n = 19, 41.3%). The increased incidence density of uncommon Candida spp. candidemia was associated with increasing use of antifungal agents. No differences in demographics, underlying comorbidities, risk factors, clinical features, dissemination, and 30-day mortality were found between uncommon Candida spp. and C. albicans candidemia. Patients with uncommon Candida spp. candidemia were more likely to require modifications in antifungal treatment and receive echinocandin drugs (43.5% vs 21.6%, p = 0.007). Candidemia caused by uncommon Candida spp. had poorer response to antifungal treatment, led to longer duration of candidemia (median 4.0 versus 2.5 days, p = 0.008), and had a higher treatment failure rate (56.5% vs 38.5%, p = 0.040).

Epidemiological features of nosocomial candidaemia in neonates, infants and children: A multicentre study in Iran

“…However, similar to other studies, we here observed that C. albicans was the predominant Candida species responsible for candidaemia, and the incidence of candidaemia associated with C albicans vs that associated with non-albicans Candida species was almost the same (49% vs 51%, respectively). 7,13,14,22 In the current study, we observed signifi- Candida tropicalis was the third most frequent causal agent of candidaemia, responsible for 18.18% mortality in patients examined in this study. Candida tropicalis appears to be more virulent than C. albicans and is more prone to causing invasive candidiasis with a high rate of mortality than the latter.…”

“…Strikingly, invasive candidiasis caused by non‐ albicans Candida species has only been reported in the past two decades . Non‐ albicans Candida species have emerged as agents of candidaemia, with an overall decreased incidence rate of C. albicans from 70% to 50% in developed countries.…”

“…Surprisingly, we isolated emerging Candida species, namely C. dubliniensis , C. fabianii , C. utilis , C. eremophila and C. melibiosica , from infected paediatric patients, which have also been previously isolated in other countries. In agreement with other studies, the majority of these emerging Candida species showed reduced susceptibility to antifungal agents . Uncommon Candida species often go undetected in routine microbiology laboratories, and the clinical significance of these species remains underestimated.…”

“…This indicates that healthcare-associated risk factors are a good predictor of positive blood culture. 6,14,[19][20][21][22][23][24][25] Strikingly, invasive candidiasis caused by non-albicans Candida species has only been reported in the past two decades. 22 Nonalbicans Candida species have emerged as agents of candidaemia, with an overall decreased incidence rate of C. albicans from 70% to 50% in developed countries.…”

“…6,14,[19][20][21][22][23][24][25] Strikingly, invasive candidiasis caused by non-albicans Candida species has only been reported in the past two decades. 22 Nonalbicans Candida species have emerged as agents of candidaemia, with an overall decreased incidence rate of C. albicans from 70% to 50% in developed countries. However, similar to other studies, we here observed that C. albicans was the predominant Candida species responsible for candidaemia, and the incidence of candidaemia associated with C albicans vs that associated with non-albicans Candida species was almost the same (49% vs 51%, respectively).…”