Candidemia due to uncommon Candida species in children: new threat and impacts on outcomes. Issue 1 (December 2018)

• Record Type: Journal Article
• Authors: Tsai, Ming-Horng; Hsu, Jen-Fu; Yang, Lan-Yan; Pan, Yu-Bin; Lai, Mei-Yin; Chu, Shih-Ming; Huang, Hsuan-Rong; Chiang, Ming-Chou; Fu, Ren-Huei; Lu, Jang-Jih
• Is Part Of: Scientific reports. Volume 8:Issue 1(2018)
• Page Start: 1
• Page End: 9
• Publication Date: 2018-12
• Subjects: Natural history -- Research -- Periodicals; Biology -- Research -- Periodicals; Physical sciences -- Research -- Periodicals; Earth sciences -- Research -- Periodicals; Environmental sciences -- Research -- Periodicals; 502.85
• DOI: 10.1038/s41598-018-33662-x
• Languages: English
• ISSNs: 2045-2322

Abstract

Abstract Many uncommonCandida spp. (species other thanC. albicans, C. parapsilosis, C. glabrata, C. tropicalis, andC. 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 uncommonCandida spp. were identified during 2003–2015 from a medical center in Taiwan. The most common specie wasC. guilliermondii (31.2%), followed byC. lusitaniae (18.8%) andC. metapsilosis (18.8%). These cases were analyzed and compared with 148 episodes ofC. albicans candidemia. The incidence density of uncommonCandida 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 uncommonCandida 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 uncommonCandida spp. andC. albicans candidemia. Patients with uncommonCandida 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 uncommonCandida 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).