Invasive Candida Infections in a Pediatric Intensive Care Unit in Turkey: Evaluation of an 11-Year Period.

Abstract

The aim of this study was to evaluate the Candida species, predisposing factors, antifungal treatment approaches, and clinical outcomes of invasive Candida infections (ICIs) in a tertiary pediatric intensive care unit (PICU). A retrospective study was performed from January 2008 to January 2019 including 102 children with ICIs who were admitted to a university hospital in southeastern Turkey. Positive blood cultures were detected in 43 (42.1%) patients, and positive urine cultures were detected in 59 (57.8%). According to our results, Candida albicans (42.2%) was the most common species for all isolates followed by C. parapsilosis (17.6%). In our patient population, non- albicans Candida species were dominant (57.8%) in all isolates. The most common facilitating factor in our study was the use of mechanical ventilator support (87.3%). The mortality rate of our patients with ICIs was 13.7%. Candida albicans was found to have the highest mortality rate among all Candida species (30.7%). When we compared patients with C. albicans and those with non- albicans Candida species in terms of risk factors, we detected a significant difference between the two groups for total parenteral nutrition use ( p  = 0.027). Fluconazole was the most preferred (58.8%) treatment option in our PICU for ICIs. Our results showed an increased trend in micafungin use in recent years. ICIs are a significant problem due to the high mortality and morbidity rates in critically ill pediatric patients in PICUs. In recent years, an increase in Candida infections caused by non- albicans Candida species has been reported. Multicenter prospective studies are needed to determine the risk factors for ICIs.