Epidemiological features of nosocomial candidaemia in neonates, infants and children: A multicentre study in Iran

Abstract

Summary Nosocomial bloodstream candidaemia is a life‐threatening fungal infection with high morbidity and mortality, especially among paediatric patients undergoing intensive immunosuppressive therapy. Limited data on the epidemiology of candidaemia and susceptibility profiles are available for Iran. To characterise candidaemia epidemiology, comorbidity risk factors, species distribution, and antifungal susceptibility profiles among paediatric patients in Iran. This observational cross‐sectional study enrolled 26 189 patients <18 years old at three reference paediatric hospitals in Mazandaran and Tehran over 2 years. Blood samples from patients with suspected fungal bloodstream infection were analysed using the BACTEC culture system. Fungal isolates were identified using matrix‐assisted laser desorption ionisation time‐of‐flight mass spectrometry (MALDI‐TOF) and DNA sequencing. Antifungal susceptibility testing was performed using the Clinical and Laboratory Standards Institute broth microdilution guideline. We observed 109 episodes of nosocomial candidaemia in paediatric patients with or without immunosuppressive therapy. The most common healthcare‐associated factor was central vascular catheter use (97%). The all‐cause mortality rate was 40%, of which 48% was attributable to candidaemia. While Candida albicans was the most frequent causative agent (49%), emerging and uncommon Candida species were also isolated. Candidaemia mortality by non‐albicans Candida species was significantly higher than that by C. albicans (P < .05). All fluconazole‐resistant species were non‐albicans Candida species. Uncommon Candida species with reduced susceptibility to antifungals are emerging as major agents of nosocomial candidaemia in high‐risk paediatric patients in Iran. Appropriate source control, antifungal regimens and improved antifungal stewardship are warranted for managing and decreasing the burden of nosocomial candidaemia.

Epidemiology of yeast species causing bloodstream infection in Tehran, Iran (2015–2017); superiority of 21-plex PCR over the Vitek 2 system for yeast identification

“…In this study we compared the performance of Vitek 2 and 21-plex PCR for yeast species identification in an epidemiological study of yeast BSIs in Iran. In our epidemiological study, C. albicans was the most prevalent Candida species isolated; this result is consistent with the findings of a previous studies conducted in paediatric patients in Tehran [ 7 , 26 ]. However, we found that C. glabrata was the second most prevalent Candida species, followed by C. parapsilosis, while Mirhendi et al found that C. parapsilosis was the second most prevalent cause of candidaemia [ 26 ].…”

Molecular epidemiology, risk factors, species distribution, antifungal susceptibility and outcome of candidemia in the capital of Iran: a prospective study

“…Candidemia patients (usually with underlying conditions, such as diabetes, cancer, pulmonary and heart complications) mostly are admitted to ICUs. The overall crude mortality of 47.2% in our study is similar to that reported by other investigators from Iran [43][44][45] but considerably higher than the 26% quoted by Chen et al [46]. Sixty patients took at least one antifungal drug and the mortality rate for these patients was 38.3% (23/60; 38.3%).…”

First Genome Sequences of Two Multidrug-Resistant Candida haemulonii var. vulnera Isolates From Pediatric Patients With Candidemia

“…However, infections caused by non-albicans Candida , such as C. parapsilosis , C. glabrata , C. tropicalis , C. krusei , and C. guilliermondii , have been increasing, usually reported in critically ill patients, sometimes with overlapping C. albicans infections. In addition, other emerging non-albicans species are described as challenging to properly identify, causing hard to treat infections ( Pfaller and Diekema, 2007 ; Wisplinghoff et al, 2014 ; Lamoth et al, 2018 ; Rodrigues et al, 2019 ; Ahangarkani et al, 2020 ).…”