Invasive Candida parapsilosis Bloodstream Infections in Children: The Antifungal Susceptibility, Clinical Characteristics and Impacts on Outcomes

Yao-Sheng Wang; Jen-Fu Hsu; Wei-Ju Lee; Shao-Hung Wang; Shih-Ming Chu; Hsuan-Rong Huang; Peng-Hong Yang; Ren-Huei Fu; Ming-Horng Tsai

doi:10.3390/microorganisms11051149

Invasive Candida parapsilosis Bloodstream Infections in Children: The Antifungal Susceptibility, Clinical Characteristics and Impacts on Outcomes

Microorganisms. 2023 Apr 28;11(5):1149. doi: 10.3390/microorganisms11051149.

Authors

Yao-Sheng Wang^{1

2}, Jen-Fu Hsu^{1

3}, Wei-Ju Lee^{1

2}, Shao-Hung Wang⁴, Shih-Ming Chu^{1

3}, Hsuan-Rong Huang^{1

3}, Peng-Hong Yang^{1

3}, Ren-Huei Fu^{1

3}, Ming-Horng Tsai^{1

5}

Affiliations

¹ College of Medicine, Chang Gung University, Taoyuan 244, Taiwan.
² Division of Pediatric Emergency Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
³ Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 244, Taiwan.
⁴ Department of Microbiology Immunology and Biopharmaceuticals, National Chiayi University, Chiayi 613, Taiwan.
⁵ Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan.

Abstract

Background: Candida parapsilosis is the most common non-albicans candida species that causes invasive candidiasis, but little is known about its impacts on the outcomes of pediatric patients. We aimed to characterize the clinical characteristics, risk factors and outcomes of C. parapsilosis bloodstream infections (BSIs) in children. Methods: All pediatric patients with Candida parapsilosis BSIs between 2005 and 2020 from a medical center in Taiwan were enrolled and analyzed. The antifungal susceptibility, clinical manifestations, management and outcomes were investigated. Cases of Candida parapsilosis BSIs were compared between patients with C. albicans BSIs and other Candida spp. BSIs. Results: During the study period, 95 episodes (26.0% of total cases) of Candida parapsilosis BSIs were identified and analyzed. No significant difference was found between pediatric patients with C. parapsilosis BSIs and those with C. albicans BSIs in terms of patients' demographics, most chronic comorbidities or risk factors. Pediatric patients with C. parapsilosis BSIs were significantly more likely to have previous azole exposure and be on total parenteral nutrition than those with C. albicans BSIs (17.9 vs. 7.6% and 76.8 vs. 63.7%, p = 0.015 and 0.029, respectively). The duration of C. parapsilosis candidemia was relatively longer, and therefore patients often required a longer duration of antifungal treatment when compared with those of C. albicans candidemia, although the candidemia-attributable mortality rates were comparable. Of the C. parapsilosis isolates, 93.7% were susceptible to all antifungal agents, and delayed appropriate antifungal treatment was an independent factor in treatment failure. Conclusions: Pediatric patients with C. parapsilosis BSIs were more likely to have previous azole exposure and be on total parenteral nutrition, and the clinical significances included a longer duration of candidemia and patients often required a longer duration of antifungal treatment.

Keywords: Candida parapsilosis; bloodstream infection; candidemia; intensive care unit; mortality.

Grants and funding

This work was supported by a grant from the Ministry of Science and Technology in Taiwan (grant no. NMRPG3H0011 and MOST 107-2314-B-182A-005).