# Pediatric candidemia due to Candida lusitaniae: A clinical and microbiological evaluation

## TL;DR

This study examines rare cases of C. lusitaniae bloodstream infections in children, focusing on risk factors, treatments, and outcomes.

## Contribution

The paper provides a detailed clinical and microbiological analysis of a rare pediatric fungal infection caused by Candida lusitaniae.

## Key findings

- C. lusitaniae accounted for 2.7% of candidemia cases in children, with most patients having underlying conditions like congenital heart disease.
- Fluconazole was the primary treatment, but combination therapy was used in refractory cases, with a 9% 30-day mortality rate observed.
- Timely catheter removal was associated with better outcomes, and resistance to L-AmB was noted.

## Abstract

Candida lusitaniae is a rare cause of invasive candidiasis in children. This study aimed to investigate the clinical and microbiologic characteristics, treatment,
and prognosis of C. lusitaniae candidemia in pediatric patients.

This retrospective study included pediatric patients (<18 years) with bloodstream infections caused by C. lusitaniae at Balcalı Hospital, Faculty of Medicine,
Cukurova University, Adana, Turkey from December 2013 to December 2021. Demographics, underlying diseases, risk factors, treatment regimens, and outcomes were analyzed.
Antifungal susceptibility was tested using the VITEK® 2 Compact system. Catheter-related bloodstream infection was defined by standard criteria.

Among 395 candidemia episodes, C. lusitaniae accounted for 11 cases (2.7%). The median age was 16 months (range: 2–177 months). Most had underlying conditions (82%),
primarily congenital heart disease (27.3%). Major risk factors included antibiotic use (100%), central venous catheter (91%), mechanical ventilation (63.6%),
intensive care unit (ICU) stay (63.6%), nasogastric tube (45.4%), surgery history (45.4%), and H2 blocker use (45.4%). The median patient age was 16 months (range: 2–177 months),
and all patients were male. Most patients (82%) had at least one underlying condition, with congenital heart disease being the most common (27.3%).
The most frequently observed risk factors included recent antibiotic use (100%), central venous catheterization (91%), mechanical ventilation (63.6%), ICU admission (63.6%),
nasogastric tube use (45.4%), surgical history (45.4%), and H2-receptor blocker administration (45.4%). Seven patients received antifungal monotherapy
with fluconazole (4/7), L-AmB (1/7), caspofungin (1/7), and micafungin (1/7). Combination antifungal therapy was initiated in three patients (30%) due to
persistent candidemia and delayed catheter removal. In these cases, combination regimens included fluconazole and caspofungin or L-AmB with additional agents.
The mean duration of antifungal therapy was 28 days (range: 12–58 days). The median time to clearance of fungemia (negative blood culture) was 15.8 days (range: 3–45 days).
Delays in catheter removal were often due to clinical instability or lack of alternative vascular access. One patient who received combination therapy died,
resulting in an overall 30-day mortality rate of 9% (1/11).

Candida lusitaniae is a rare nosocomial pathogen in children with underlying conditions and risk factors. Fluconazole remains a primary treatment option, although combination therapy may be warranted in refractory cases. Given the potential resistance to L-AmB, caution is advised in its use. Timely catheter removal is associated with improved outcomes. Further studies are needed to establish optimal therapeutic strategies for this rare infection.