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. 2024 Oct 10;10(10):707.
doi: 10.3390/jof10100707.

Prevalence, Species Distribution and Resistance of Candidemia in Pediatric and Adult Patients in a Northeast Italy University Hospital

Silvia Meneghello  1 , Giulia Bernabè  2 , Giuseppe Di Pietra  1 , Sarah Di Sopra  1 , Claudia Del Vecchio  1   2 , Anna Maria Cattelan  2   3 , Ignazio Castagliuolo  1   2 , Paola Brun  2
Affiliations

Prevalence, Species Distribution and Resistance of Candidemia in Pediatric and Adult Patients in a Northeast Italy University Hospital

Silvia Meneghello et al. J Fungi (Basel). .

Abstract

Candidemia and invasive candidiasis (IC) are causes of morbidity and mortality in healthcare settings, with notable differences between children and adults. Understanding the species distribution and antimicrobial susceptibility profiles of clinical isolates can guide empiric therapy in patients at risk of IC. This study investigated the incidence and antifungal susceptibility patterns of yeasts involved in IC in pediatric and adult patients from 2019 to 2023. The average incidence of IC was 0.715 per 1000 patients, increasing over the study period; infants had the highest incidence rates. Over half of the IC episodes occurred in intensive care units (ICUs). Non-albicans Candida (NAC) species represented the most frequently isolated species in adults and children (55.96% and 50.0%, respectively), with the prevalence of C. parapsilosis (26.45% and 14.7%, respectively), N. glabratus (14.97% and 8.82%, respectively) and C. tropicalis (4.36% and 2.94%, respectively). C. lusitaniae was identified in 14.7% of pediatric IC cases. In NAC species, antifungal resistance has also increased over the five years of the study: 69.12% were resistant to azoles and 7.35% were resistant to micafungin. Resistance was higher in pediatric patients. Our study highlights differences in IC characteristics between pediatric and adult populations and emphasizes the importance of targeted antifungal stewardship in ICU patients with NAC invasive infections.

Keywords: Candida; bloodstream infections; epidemiology; non-albicans Candida; resistance; uncommon Candida.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The overall incidence of invasive candidiasis (IC) episodes per 1000 patients admitted to Padova University Hospital between 2019 and 2023. For each year, the incidence value is reported; the dotted orange line indicates the calculated average incidence (A). The annual incidence of IC by age group; yo: years old (B). Gender distribution of patients with IC; yo: years old (C).
Figure 2
Figure 2
Distribution of clinical isolates of invasive candidiasis (IC). Episodes of IC were tallied by species and year and graphed (A). Episodes of IC were tallied by species and age of patients and graphed; yo: years old (B). Episodes of IC in the pediatric population (0–14 yo) were tallied by species and wards of the first identification; ICUs: intensive care units; ER: emergency room (C). Episodes of IC in patients aged 15–>70 years were tallied by species and wards of the first identification; general wards: long-stay units (D).
Figure 3
Figure 3
Antifungal resistance in clinical isolates of invasive candidiasis (IC). Candida spp. were clustered for resistance; FCZ: Fluconazole; VOR: Voriconazole; ANI: Anidulafungin; CAS: Caspofungin; MCF: Micafungin; POS: Posaconazole; AmB: Amphotericin B (A). Candida spp. were clustered for resistance to azoles (FCZ, VOR, POS), amphotericin (AmB) or echinocandins (ANI, CAS, MCF) and age of the patients; yo: years old (B,C). Candida spp. were clustered for resistance to azoles (left panel) or echinocandins (right panel) and year of isolation (D). Episodes of Candida spp. were clustered for resistance to azoles (left panel) or echinocandins (right panel) and the ward of the first isolation; ICU: intensive care unit (E).
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