Epidemiology, Risk Factors and Outcome of Candida parapsilosis Bloodstream Infection in Children

Abstract

Background Candida parapsilosis constitutes a common Candida spp. isolated in children with candidemia. Few data exist on risk factors and outcome of candidemia caused by C. parapsilosis in pediatric patients. Methods We conducted a retrospective analysis of demographic data, clinical features, therapeutic procedures and outcomes associated with Candida bloodstream infections (BSIs) that occurred at the Children’s Hospital of Philadelphia between 1997–2009. Results Among 406 Candida BSIs, Candida albicans accounted for 198 (49%), C. parapsilosis for 99 (24%) and all other species for 109 (27%) episodes. There was no consistent change in proportion of C. parapsilosis BSIs during the study. C. parapsilosis BSI was more frequent than non-parapsilosis Candida spp. at age ≤2 years as compared with older patients [62% vs. 50%; OR=1.24, 95% CI=1.03–1.51, p=0.038]. Patients with C. parapsilosis were more likely to be mechanically ventilated within 48 hours of BSI (OR=1.38, 95% CI=1.01–1.85, p=0.047). Presence of a urinary catheter a week before infection was a protective factor for developing candidemia due to C. parapsilosis spp. (p=0.003). No significant differences were found between the two groups in presence of central intravascular catheters, co-morbidities and clinical or surgical procedures, previous administration of immunosuppressive or antifungal agents and mortality. Conclusions C. parapsilosis is the second most frequent cause of candidemia after C. albicans. While it is more frequent at the age of ≤2 years and is more likely associated with mechanical ventilation than other Candida spp., mortality does not significantly differ between those with and without C. parapsilosis candidemia.

Results From a Prospective, International, Epidemiologic Study of Invasive Candidiasis in Children and Neonates

“…12,14,24 In the MSGsponsored observational study, 12 the mean age of pediatric patients was only 8 months, which could explain why their Candida species distribution was more similar to that of our neonatal patients. We found that C. albicans was the most frequently occurring species, but non-albicans Candida species predominated overall.…”

Microbial epidemiology of candidaemia in neonatal and paediatric intensive care units at the Children's Medical Center, Tehran

“…Candida parapsilosis was the second‐most common isolated Candida species across all patients in the present study. Colonisation of infant skin by horizontal transmission from the colonised hands of health care workers who have direct contact with patients can lead to CVC‐related infection with C. parapsilosis . Its high ability to adhere to/form biofilm on foreign materials and grow on glucose‐ and amino acid‐rich parenteral nutrition solutions are the main risk factors for infections by this species .…”

Investigation of OCH1 in the Virulence of Candida parapsilosis Using a New Neonatal Mouse Model

“…While Candida albicans is the leading cause of invasive candidiasis in general, children under the age of 2 are at greater risk of infections caused by C. parapsilosis , an emerging non- albicans Candida species (Dotis et al, 2012; Juyal et al, 2013; Jordan et al, 2014). …”