G53 Epidemiological and microbiological trends in candidaemia in a tertiary paediatric uk hospital

Abstract

Aims To describe the demographics of patients diagnosed with candidaemia, and to explore speciation and susceptibility trends in Candida organisms grown in blood cultures over 15 years in a single tertiary care paediatric hospital in the UK. Method Local laboratory records were accessed to obtain data about all positive blood cultures for Candida species between January 2001 and December 2015. A retrospective analysis of available electronic medical records was completed. Data was input and analysed using Microsoft Excel. Results There were 192 episodes of candidaemia, with 23 patients having multiple episodes of candidaemia (i.e. separated by >30 days). Patient’s ages ranged from 5 days to 18 years, with a mean of 5 years and 6 months. There were 85 females (44%) and 107 males (56%). The patient’s locations at the time of the candidaemia varied from the general paediatric wards (61, 32%), haematology/oncology wards (52, 27%), ICU (49, 26%), and paediatric surgical wards (30, 16%). The outcome of the patients after 30 days showed that 85 remained in hospital (44%), 81 had been discharged home (42%) and 26 had died (14%). The two most common candida species identified were Candida albicans (96, 50%) and Candida parapsilosis (56, 29%). There was a lower incidence of recognised resistant species such as Candida lusitaniae (9, 5%), Candida glabrata (7, 4%), and Candida krusei (3, 2%) with no increase in incidence of these species seen over time. The majority of samples (181, 94%) underwent sensitivity testing for a selection of seven common antifungal medications (amphotericin, caspofungin, fluconazole, flucytosine, itraconazole, micafungin and voriconazole). Eight samples of Candida albicans had resistance to a specific antifungal: 2 to fluconazole, 1 to flucytosine, 4 to itraconazole and 1 to voriconazole. No samples of Candida parapsilosis had resistance to any of the antifungals tested, however 16 had intermediate resistance to caspofungin. Conclusions This 15 year study of candidaemia in a tertiary paediatric hospital shows that almost 80% of the cases were due to Candida albicans or Candida parapsilosis. Resistant Candida species and overall resistance to antifungal medication was uncommon and did not show any increasing trend over time.