Treatment Options and Antifungal Resistance in Pediatric Candidozyma auris (Previously Candida auris) Infections: A Systematic Review of Clinical Outcomes

TL;DR

This review examines treatment and resistance patterns in children with Candidozyma auris infections, highlighting high mortality and the need for better antifungal strategies.

Contribution

The study provides a systematic review of pediatric C. auris infections, focusing on treatment outcomes and resistance profiles.

Findings

C. auris infections in children commonly result in bloodstream infections with a 35% mortality rate.

Echinocandins are most frequently used and associated with survival, but resistance is emerging.

Combination therapy shows higher survival rates, though results are inconclusive due to small sample sizes.

Abstract

Candidozyma auris (previously named Candida auris) has been recognized as a significant public health threat due to its extensive transmission in hospital settings, high mortality rates, and multidrug resistance. Evidence regarding optimal antifungal treatment in children remains limited. The present systematic review aims to synthesize available evidence on pediatric C. auris infections, focusing on antifungal treatment, resistance profiles, and clinical outcomes. A systematic search was conducted across PubMed, Scopus, and Web of Science, identifying case reports and case series of pediatric patients with confirmed C. auris infection. Data were extracted on demographics, comorbidities, infection site, antifungal therapy, and outcomes. Risk of bias was assessed using JBI Critical Appraisal checklists. Fourteen studies comprising 62 patients were included, with most cases being bloodstream infections. C. auris showed widespread fluconazole resistance and variable susceptibility to amphotericin B. Echinocandins were the most commonly used agents, generally associated with survival. Overall mortality was 35%, similar to that reported for adults. Combination therapy showed numerically higher survival, although given the small sample size and heterogeneity of treatment regimens, no comparative inferences can be made. Pediatric C. auris infections mirror adult patterns of antifungal resistance and mortality. Echinocandins remain first line therapy; however, the emergence of echinocandin resistance underscores the urgent need for antifungal stewardship, standardized pediatric guidelines, and novel antifungal development.

Figures