Candidemia in a Pediatric Population: A 10-year Indian Study

Abstract

Introduction: Candidemia has emerged as one of the life-threatening causes of invasive infection in both adults and children worldwide. Materials and methods: We performed a retrospective study of children (≤16 years) with candidemia diagnosed in our center in 2010 to 2019. Demographics, comorbidities, Candida species distribution, antifungal susceptibility, and outcomes were analyzed. Results: A total of 96 children were identified in the last 10 years. The predominant species identified were C. tropicalis (23%), C. parapsilosis (15.6%), C. pelliculosa (15.6%), C. albicans (13.6%), C. krusei (7.3%), and C. haemulonii (5.2%). Male to female ratio was 2:1. The most common risk factor was found to be congenital malformations (27%), followed by hematological malignancy in 13.5%. Candidemia was diagnosed while being admitted in the intensive care unit in 74%, 14.5% in wards, and 11.5% in outpatients. The overall mortality rate was found to be 31.3%. C. tropicalis was found to be sensitive to fluconazole in 95.5%, flucytocine in 95.2%, and 100% susceptible to amphotericin B, voriconazole, and caspofungin. Conclusion:Invasive candidiasis occurs frequently in hospitalized patients and is associated with high mortality rates. C. tropicalis was the most frequently isolated species. We have observed a shift in Candida spp. with an increasing isolation of C. pelliculosa. The occurrence of azole resistance is a matter of concern. Clinical significance: This type of data analysis is needed to track trends of serious infection and to develop guidelines for infection control strategies and antimicrobial stewardship program.

Oral Candida colonization and anti-fungal susceptibility pattern in patients with hematological malignancy

“…Prophylactic antifungal treatment is effective in a wide range of organisms and is available intravenously and orally [ 22 ]. These species show higher levels of resistance to antifungal interventions and are associated with higher mortality from C. albicans [ 23 , 24 ]. In our study, 46% of patients received antifungal prophylaxis, and FCZ obtained the highest consumption among other prophylaxis (26%).…”

“…The main reason for these changes could be the use of FCZ as the first-line treatment in these patients, the emergence of resistance due to the use of broad-spectrum antibiotics, and the utilization of potent malignancy treatment protocols. Tracing serious infections and developing guidelines for infection control strategies and antifungal monitoring programs are essential [ 23 ]. Antifungal drugs, such as FCZ, itraconazole, posaconazole, CAS, and micafungin are all recommended with many consensus and guidelines for antifungal prophylaxis.…”