Title : Clinical profile of candidemia in children: A 10-year experience from a tertiary care centre in India
Abstract:
Background: Systemic fungal infections cause significant morbidity and mortality in children. Antifungal resistance is a matter of concern, as choice of antifungal therapy for empirical and therapeutic purposes is guided by existing sensitivity patterns among Candida isolates.
Rationale of the Study: Data on Candida bloodstream infections in pediatric patients from India remain limited. This is the largest single centre study from India. This study was done in NABL-accredited microbiology laboratory that serves as a WHO reference and regional reference centre.
Objectives: The primary objective of the study was to describe the clinical profile of paediatric patients developing blood stream Candida infection, and to examine the microbiological profile of blood stream Candida strains isolated in children. Since our most common blood culture isolate was Candida tropicalis, the secondary objective was to compare the clinical factors associated with developing C. tropicalis vs. non-tropicalis spp. blood stream infection, to study the available antifungal sensitivity of various species, and to identify factors associated with poor outcome.
Methodology: This was a retrospective study in children less than 16 years with blood stream Candida infection in a tertiary health care centre in India. Data was collected from medical and laboratory records over a 10-year period between 1 January, 2013 and 31 December, 2022. Data was tabulated and analysed using SPSS software 21.0.
Results: There were 243 children identified in the 10-year study period. Median age at diagnosis was 1 year. Common clinical manifestations were fever (47.5%) and shock (60%). Most common co-morbid condition was haematological malignancy (15.6%), followed by cardiovascular diseases (7.8%). Most common Candida species isolated was C. tropicalis (43%), followed by C. albicans (14.8%). For the C. tropicalis isolates that were tested, fluconazole sensitivity was 87%, amphotericin sensitivity was 92%, voriconazole sensitivity was 33%, and caspofungin sensitivity was 88%. For C. albicans, Fluconazole was sensitive in 77%, amphotericin sensitive in 100%, voriconazole sensitive in 33% and caspofungin was 100% sensitive. Disseminated candidiasis was seen in 10%, with hepato-splenic being the most common involvement. Candida attributable mortality was 18.5%. Significant overall predictors of mortality included malnutrition, shock requiring inotropic support and thrombocytopenia.
Conclusions: Majority of the candidemia was caused by C. tropicalis species. Candidemia in children resulted in high mortality. Overall antifungal susceptibility was highest for amphotericin and echinocandins, moderate for fluconazole, and low for voriconazole across Candida species. Malnutrition, use of inotropic support and thrombocytopenia were significant predictors of poor outcomes.
