Epidemiology, risk factors and clinical properties of invasive candida infections in children

Dokuz Eylül University Faculty of Medicine, Department of Pediatrics Introduction and Aim: Candida is the most important cause of fungal infection. Especially affects premature, patients with immunodeficiency, with chronic illness and critically sick patients. Considering the significant morbidity and mortality potential of invasive candidiasis, special attention should be paid to the pediatric population. The aim of this study was to determine the distribution of Candida species, risk factors for invasive candidiasis, antifungal resistance status of isolated Candida spp., the effect of antifungal therapy and antifungal susceptibilities on clinical outcomes and the factors affecting mortality in children with invasive candidiasis. Demographic characteristics, risk factors and clinical outcomes of patients with invasive infection due to C. albicans and non-albicans Candida spp., C. parapsilosis and non-parapsilosis Candida spp. were compared. Material and Methods: Patients who were found to have Candida growth in sterile body region cultures between September 2014 and September 2018 were determined from mycology laboratory records and the patient information were retrospectively analyzed.Demographic, microbiological and clinical data of the patients were recorded. The susceptibilities of Candida spp. to fluconazole, caspofungin and amphotericin B were determined by microdilution method. Findings: Fifty two Candia spp. were detected in 49 invasive candidiasis episodes of 45 different patients during the study period. The median age of patients with Candida infection was 11.1 months. Twenty of the patients were female (45 %) and 25 were male (55 %). All patients had at least one risk factor for Candida infection. The most common risk factors were the underlying disease (100 %), antimicrobial therapy (96 %), CVC (71 %), parenteral nutrition (47 %), hospitalization in intensive care unit (47 %), last three months history of hospitalization (59 %) and mechanical ventilation (49 %). Twentieth (38.46 %) of isolated Candida spp. were related to C. albicans and 32 (61.53 %) were related to non-albicans Candida species. The most commonly isolated species was C. parapsilosis (44.23 %), C. albicans (38,46 %), C.tropicalis (5,76 %), C. glabrata (1,92 %), C. lusitaniaea (3,84 %), C. krusei (3,84 %), and C. pelliculosa (1.92 %). Catheter-related infection (69 %), endocarditis (4 %) and peritonitis (2 %) were detected in invasive Candida infections. The most common clinical finding was fever (79.6 %). Anti-fungal susceptibility test was performed in 37 patients. Twelve (32 %) of them were susceptible to fluconazole, one (2 %) of them was dose-dependent susceptible and 14 of them (37 %) were resistant. Dedection of susceptibility was for amphotericin B 97.3 % and for caspofungin 97 %. The sensitivity of fluconazole in albicans and non-albicans Candida spp. was 100 % and 37.8 %, respectively. The amphotericin B sensitivities of C. albicans and non-albicans Candida were 100 % and 96 %, respectively. The caspofungin sensitivity in C. albicans and non-albicans Candida spp. was 92 %, 100 %, respectively. The overall mortality rate of invasive candidiasis in children was 14 %. Dialysis, TPN, neutropenia and the use of antifungal agent before invasive candidiasis associated with mortality. There was no statistically significant difference between C. albicans and non-albicans Candida spp. in terms of demographic, clinical, antifungal susceptibility and mortality. Compared with C. parapsilosis and non-parapsilosis Candida spp., prolonged hospitalization was significantly higher in those with C. parapsilosis, but there was no significant difference in demographic, clinical features and mortality. Conclusion: As a result, non-albicans Candida spp. were the most common agents in children with invasive candidiasis. The sensitivity to fluconazole of non- albicans Candida spp. was found to be 37.8 %. Dialysis, TPN, neutropenia and the use of antifungal agent before invasive candidiasis are risk factors that increase mortality. Prolonged hospitalization in invasive Candida infections due to C. parapsilosis is a significant risk factor. Knowledge of local epidemiological data in invasive Candida infections is important in empirical treatment. Keywords:Invasive Candida infection, children, risk factors, antifungal susceptibility.