Abstract
Many uncommon Candida spp. (species other than C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, and C. krusei) have been shown to emerge in tertiary care facilities. We aimed to investigate these uncommon candidemia in children. Forty-six cases of candidemia caused by uncommon Candida spp. were identified during 2003–2015 from a medical center in Taiwan. The most common specie was C. guilliermondii (31.2%), followed by C. lusitaniae (18.8%) and C. metapsilosis (18.8%). These cases were analyzed and compared with 148 episodes of C. albicans candidemia. The incidence density of uncommon Candida spp. candidemia and the proportion to all candidemia episodes increased substantively during the study period. Prior exposure to azoles was uncommon in the 30 days prior to infection, but fluconazole resistant strains were significantly more common (n = 19, 41.3%). The increased incidence density of uncommon Candida spp. candidemia was associated with increasing use of antifungal agents. No differences in demographics, underlying comorbidities, risk factors, clinical features, dissemination, and 30-day mortality were found between uncommon Candida spp. and C. albicans candidemia. Patients with uncommon Candida spp. candidemia were more likely to require modifications in antifungal treatment and receive echinocandin drugs (43.5% vs 21.6%, p = 0.007). Candidemia caused by uncommon Candida spp. had poorer response to antifungal treatment, led to longer duration of candidemia (median 4.0 versus 2.5 days, p = 0.008), and had a higher treatment failure rate (56.5% vs 38.5%, p = 0.040).
Highlights
Candidemia is a major cause of morbidity and mortality in the health care setting, especially among critically ill or immunocompromised patients or those with complicated medical conditions[1,2,3]
Because most institutions have had limited experience with candidemia caused by these uncommon Candida spp. in children, we conducted an observational study of all candidemia cases caused by these pathogens that occurred at our institution during a 13-year period
We identified 323 episodes of candidemia that occurred in hospitalized children over the 13-year study period
Summary
Candidemia is a major cause of morbidity and mortality in the health care setting, especially among critically ill or immunocompromised patients or those with complicated medical conditions[1,2,3]. Candidemia caused by other uncommon species, including C. haemulonii, C. guilliermondii, and C. lusitaniae, is less well known and data have been reported only in small case series[7,8,9,10,11,12]. These uncommon fungal species have emerged as a new health threat to hospitalized patients and are endemic in some areas[10,11,12]. Because most institutions have had limited experience with candidemia caused by these uncommon Candida spp. in children, we conducted an observational study of all candidemia cases caused by these pathogens that occurred at our institution during a 13-year period
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