Overview of Candida parapsilosis candidemia in pediatric patients with hematologic and solid organ malignancies

TL;DR

This study examines Candida parapsilosis infections in children with cancer, finding higher rates in those with blood cancers and highlighting treatment and resistance patterns.

Contribution

The study provides insights into the clinical and demographic features of C. parapsilosis candidemia in pediatric cancer patients and reports antifungal susceptibility profiles.

Findings

Catheter-related candidemia was more common in patients with hematologic malignancies.

Caspofungin resistance was not detected among C. parapsilosis isolates.

Amphotericin B and caspofungin were the most frequently used treatments.

Abstract

Today, with the development of critical patient care and the increase in intravascular invasive methods, the survival rate of patients diagnosed with hematological and solid organ
malignancies is increasing, and unfortunately, the incidence of Candida parapsilosis candidemia is also increasing due to multiple risk factors.
In this study, we aimed to determine the clinical-demographic characteristics of C. parapsilosis candidemia and the antifungal susceptibility profile of C. parapsilosis in pediatric patients with hematological and solid organ malignancies.

The present study included pediatric patients with hematologic and solid organ malignancies presenting with signs and symptoms consistent with candidemia,
in whom C. parapsilosis was isolated from blood and catheter cultures between January 2010 and August 2023.

Thirty (65.2%) of the patients had hematologic and 16 (34.8%) had solid organ malignancies. In all patients, 23 (50%) had non-catheter-related candidemia and 23 (50%) had catheter-related
candidemia. At least one of the risk factors examined was detected in these patients. Catheter-related candidemia was found to be more common in patients diagnosed with hematologic malignancy.
The difference was found to be statistically significant (p= 0.030). Drug resistance rates of C. parapsilosis were 6.5% for amphotericin B, 6.5% for fluconazole, 2.2% for voriconazole
and 2.2% for micafungin. No patient with caspofungin resistance was detected. The mean treatment duration of the patients was 21 days (min 3-max 103) and it was
observed that amphotericin B and caspofungin were used most frequently in the treatment regimen. The mortality rate of patients with candidemia was 6.5%.

Our study showed that patients with hematologic malignancies exhibited a higher susceptibility to catheter-related C. parapsilosis candidemia compared to
patients with solid organ tumors. Caspofungin resistance was not detected in our study, and we believe that each center should know its own antifungal drug sensitivity,
determine the treatment regimen accordingly, and that catheters should be removed rapidly in patients with catheter-related C. parapsilosis candidemia in malignant patients.

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