Prevalence and outcome of candidemia among paediatric cancer patients: A single centre experience from India

Abstract

Background: Candida species are one of the leading causes of invasive fungal infections in pediatric patients with cancer, resulting in increased treatment related morbidity and mortality. There is limited data with respect to demography and outcomes of candidemia among children with cancer, especially from lower-middle income countries.

Methods: In this retrospective observational study conducted over a 4-year Period (January-2017 to December-2021), children less than 15 years with cancer, treated at a tertiary oncology centre in India and diagnosed with candidemia were included. Data with respect to risk factors, species types, treatment, complications and mortality was gathered.

Results: One-hundred and ten children with candidemia were included. The most common underlying malignancy was acute leukemia seen in 72 (66%) patients. Seventy-five (68%) patients had neutropenia (<0.5 × 10^9/L) at the time of diagnosis of candidemia. In addition, 35 (32%) and 34 (30%) patients had prolonged exposure to steroids and antibiotics respectively. Non-albicans Candida species was isolated in majority (90%) of the cases. Fifty-seven patients required some form of modification of therapy for underlying malignancy. The 30-day mortality of the entire cohort was 36% and was 73% for patients admitted to the intensive care unit. On multivariate analysis, only prolonged use of antibiotics [odds ratio: 2.7(1.1-6.7); p = 0.027] was found to be significantly associated with worse 30-day mortality.

Conclusion: The present study highlights the burden of candidemia among children with cancer. Despite prompt therapy, our cohort experienced increased mortality, primarily associated with prolonged antibiotic usage. These findings reinforce the critical importance of strict adherence to infection control guidelines and prudent antibiotic stewardship practices to improve patient outcomes.

Keywords: Antifungals; Candidemia; Central venous catheter; Pediatric cancer.