Evaluation of Candidemia Due to Uncommon Candida Species in Children: A Multicenter Retrospective Study.
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BACKGROUND: Candidemia is a life-threatening infection, and uncommon Candida species (UCS) are increasingly reported in pediatric patients. We aimed to evaluate the demographic and clinical characteristics of UCS candidemia in children. MATERIALS AND METHODS: This multicenter retrospective study included pediatric patients with UCS candidemia (species other than Candida albicans , Candida parapsilosis , Candida glabrata , Candida tropicalis and Candida krusei ) from 14 tertiary hospitals in Turkey between January 2013 and December 2023. RESULTS: A total of 221 episodes in 204 patients were analyzed. The median age was 29 months (interquartile range [IQR]: 7.8-78.5), and 58.8% were male. The most common UCS were Candida lusitaniae (n = 44, 19.9%), Candida kefyr (n = 40, 18.1%) and Candida guilliermondii (n = 31, 14%). Hematologic malignancy was the most frequent underlying condition (n = 50, 22.6%). Central venous catheters (CVC) were present in 76% (n = 168) of patients and were removed in 67.9% (n = 114) of episodes. Immunosuppressive therapy and recent surgery were documented in 53.8% (n = 119) and 53.4% (n = 118) of episodes, respectively, while total parenteral nutrition was used in 44.3% (n = 98). Recent antibiotic exposure was observed in 95.5% (n = 211) of episodes, and concomitant bacteremia occurred in 27.1% (n = 60). Neutropenia and thrombocytopenia were present in 59.7% (n = 132) and 48% (n = 106) of episodes, respectively. Antifungal prophylaxis was recorded in 23.5% (n = 52) of episodes, predominantly with fluconazole (76.9%). Susceptibility rates were 89.2% (116/130) for fluconazole, 90.4% (113/125) for caspofungin and 85.7% (102/119) for amphotericin B. Pediatric intensive care unit admission was required in 25.8% (n = 57) of episodes. The 7-day and 30-day mortality rates were 7.2% (n = 16) and 14.5% (n = 32), respectively. Female sex and longer hospital stay before infection were associated with increased mortality (7-day: P = 0.04 and P = 0.047; 30-day: P = 0.02 and P = 0.023). Mechanical ventilation, urinary catheterization and total parenteral nutrition were more frequent among nonsurvivors in both mortality periods (7-day: P < 0.001, P = 0.03, P < 0.001; 30-day: P < 0.001, P < 0.001, P = 0.03). The CVC removal rate was lower in mortality groups than in survivors (7-day: P = 0.005 and 30-day: P = 0.006).Thrombocytopenia was associated with both 7-day and 30-day mortality ( P < 0.001 and P = 0.001), while elevated C-reactive protein levels were associated with 7-day mortality ( P = 0.046). CONCLUSIONS: UCS candidemia in children most commonly occurred in patients with solid-hematologic malignancy, central venous catheters and recent antibiotic exposure within 1 week. Female sex, prolonged pre-infection hospitalization, intensive care-related interventions, thrombocytopenia, lower CVC removal rate and elevated C-reactive protein were associated with increased short-term mortality.