Epidemiology of Candidemia in Children and Neonates in Korea, 2009-2018: A Multi-Center Study

Abstract

Background: Invasive candidal infection is a serious health threat to high-risk pediatric populations. Data on pediatric epidemiology of candidemia in Korea are limited. Methods: A retrospective chart review was performed for patients aged 0-18 years who were diagnosed with candidemia from 2009 to 2018 in tertiary hospitals. Patients were divided into two groups; a neonatal group of babies with postnatal age 28 days or younger or any patients hospitalized in neonatal intensive care unit and a pediatric group of the rest of patients. Only the first candidemia episode for each patient was included. Candida species, antifungal sensitivity, underlying condition, and outcomes were investigated. Results: A total of 228 patients with candidemia were identified from five hospitals. Of them, 87 and 141 were assigned into the neonatal group and the pediatric group, respectively. The most common underlying condition was prematurity (88.5%) in the neonatal group and hematology-oncology diseases (49.6%) in the pediatric group. Non-albicans Candida spp. (65.4%) was more common than C. albicans. C. parapsilosis was the most commonly identified species (35.1%), followed by C. albicans (34.6%), C. tropicalis (9.6%), C. glabrata (9.6%), and C. krusei (2.2%) in all patients. C. parapsilosis was the most common pathogen in the neonatal group, while C. albicans was the most common pathogen in the pediatric group. Results of antifungal sensitivity to fluconazole were available for 160 patients. About 11.2% of isolates were either intermediate or resistant to fluconazole (10.0% for non-albicans, 1.2% for C. albicans) (P = 0.036). Overall mortality within 30 days after candidemia was 25.4%. Conclusion: Candidemia caused by non-albicans Candida was more common in pediatric patients during the study period. Resistance to antifungal agents was noted. Monitoring for epidemiologic change is warranted.