Candidemia in Non-neutropenic Pediatric Patients in an Intensive Care Unit

Aim: Candidemia has high morbidity and mortality rate in critically ill patients hospitalized in intensive care units. Prompt initiation of accurate anti-fungal therapy is essential for survival. In this study, a 6-year retrospective candidemia analysis of pediatric intensive care unit (PICU) was performed to review candida species distribution, risk factors for candidemia and change in the antifungal resistance in years. Material and Method: The candidemia episodes of children followed in the PICU of XXX Hospital between January 2014 and January 2020 were analyzed. The demographic and clinical characteristics, laboratory findings, treatments and outcomes of the patients were obtained from the medical records. Results: Fifty-nine episodes of candidemia (54.2% female) were reported in six years, median age at diagnosis was 43 months (range 1-225), median hospital stay was 48 days (range 3-664). All patients had used broad-spectrum antibiotics, majority had comorbidities (89.8%), nasogastric tube (84.7), central venous catheter (78.0%), and on mechanic ventilation (76.3%). Type of candida species was identified in 36 episodes of candidemia; 47.2% of these episodes were caused by C. parapsilosis, 38,9% by C. albicans, 8.3% by C. glabrata (8.3%), 2.8% by C. lusitaniae, and 2.8% by C. tropicalis. Length of hospital stay was longer among patients with nonalbicans candidemia, and these patients had higher leucocyte count at diagnosis. The rate of antifungal resistance increased over the years. Overall, thirty-day mortality rate was 16.9%. Conclusion: For critically ill patients with markedly elevated leucocyte count and long hospital stay, empiric antifungal treatment should cover nonalbicans candida with antifungal resistance.