Persistent candidemia in pediatrics: exploring risk factors.
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OBJECTIVE: Persistent candidemia (PC) in children can lead to unfavorable outcomes. However, its risk factors and clinical impact remain poorly understood. This study aimed to identify risk factors associated with PC in pediatric patients. METHOD: We conducted a retrospective analysis of 141 children (0-17 years) diagnosed with candidemia at a children's hospital in Brazil between 2016 and 2022. Clinical data were collected from medical records. Microorganisms were identified by MALDI-TOF MS, tested for biofilm production, and sensitivity profile. Molecular typing was performed on the three most prevalent species, and ERG11 mutation screening was carried out on fluconazole-resistant isolates. RESULTS: PC was identified in 34.8% (n = 49) patients. Independent risk factors included early non-removal of the central venous catheter, parenteral nutrition, and cancer. The overall 30-day mortality was 23.4%, and the candidemia-related mortality was 16.3%. C. parapsilosis was the prevalent species. All isolates except one produced biofilm. One isolate of C. tropicalis, which had the missense mutation Y257H in ERG11, was resistant to fluconazole. Isolates showed high genetic diversity. CONCLUSIONS: PC was associated with host factors and clinical management rather than aspects of the etiological agent, highlighting the importance of early patient monitoring.