Changing face of Candida colonization pattern in pediatric patients with hematological malignancy during repeated hospitalizations, results of a prospective observational study (2016–2017) in shiraz, Iran

Abstract

Background Surveillance of current changes in the epidemiology of Invasive Fungal Diseases (IFDs) as an important component of the antifungal stewardship programs (ASP), requires careful regular monitoring, especially in high-risk settings such as oncology centers. This study aimed to examine Candida colonization status and corresponding current changes in children with malignancy during repeated admissions and also investigate the possible epidemiological shifts after the implementation of ASP. Methods In this prospective observational study, all eligible patients younger than 18 years were recruited during 2016–2017 at Amir Medical Oncology Center (AMOC) in Shiraz, Iran. Totally, 136 patients were enrolled and 482 samples were collected from different sites (oral/nasal discharges, urine and stool). Weekly regular sampling was carried out during hospitalization. Candida colonization status and epidemiological changes were monitored during repeated admissions. Samples were cultivated on Sabouraud Dextrose agar medium and identified by Polymerase Chain Reaction -Restriction Fragment Length Polymorphism (PCR-RFLP). Results Estimated Candida colonization incidence was 59.9% (82/136) in our patients. Candida colonization was found to be higher in oral cavity and rectum than that in nasal cavity. Among those long-term follow ups and repetitive hospitalizations, a significant number of patients exhibited changes in their colonization patterns (37.7%). Candida colonization did not reveal any significant relationship with age, sex, oncologic diseases and degree of neutropenia. C. albicans (72.0%) was found as the most common Candida species in colonized patients, followed by C. krusei , C. kefyr , C. glabrata and C. parapsilosis . Conclusion Given the high incidence of Candida infections in children with cancers, close monitoring of epidemiologic changes is essential for judicious management, based on local surveillance data and improvement of overall quality of care in high risk patients.

Candida kefyr in Kuwait: Prevalence, antifungal drug susceptibility and genotypic heterogeneity

“…Candida kefyr ( Kluyveromyces marxianus ), an ascomycetous yeast occasionally isolated from dairy products [ 16 , 17 ], has also been isolated from a variety of clinical specimens including invasive samples and from the hands of health care workers [ 14 , 18 – 21 ]. Recent reports suggest that C .…”

Impact of antifungal stewardship interventions on the susceptibility of Candida species in pediatric patients with malignancy

“…Although C. albicans is the most common cause of Candida infections, the prevalence of non-albicans species is increasing [6]. The emergence of non-albicans Candida infections have become a global concern; however, as we described previously, change in its epidemiology after adherence to the AFS program was observed [11]. Similar positive effects could be expected by improving the susceptibility pattern of Candida spices after AFS implementation.…”

“…C. krusei, C. kefyr, C. glaberata, C. parapsilosis, C. tropicalis, and C. famata were the least common Candida species. Detail information regarding the colonization pattern of the studied cases can be found in our recently published paper [11].…”

“…During period 1 (p1), 46.5% (88) of the studied cases (n = 188) were colonized, while in the 2nd period, the colonization rate reached 59.9% (P value = 0. 0.017) [11]. In total, 25.3% (23) of the cases were receiving antifungal prophylaxis during the 2nd period, mainly with the liposomal formulation of amphotericin B, while 54% were on antifungal prophylaxis during p1, mostly with uconazole or itraconazole [Difference 21.2%, 95% CI: 9.16-31.77%, P = 0.0007].…”

“…As discussed earlier, during p1, more than 35% of cases were colonized with non-albicans species, mostly C. glabrata and C. krusei. However, after the implementation of the AFS, non-albicans colonization decreased to less than 20%, mostly C. krusei and C. Parapsilosis, with a signi cant decrease in C. glabrata colonization [11]. C. glabrata is considered as the second most common gastrointestinal yeast ora, after C. albicans [33].…”