Epidemiology, clinical features, antifungal resistance, and prognosis of fungemia in pediatric patients.

INTRODUCTION

The aim of this study was to investigate the epidemiology, clinical characteristics, antifungal susceptibility, and prognosis of fungemia among pediatric patients.

METHODOLOGY: A retrospective cohort analysis was conducted on 195 fungemia cases at Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital over a 7-year period (2016-2023). Comprehensive clinical data were extracted from the electronic medical record system.

RESULTS

Microbiological analysis of 195 fungemia cases revealed 22 distinct fungal species. Candida parapsilosis was the predominant pathogen (28.2%, 55/195), followed by Candida albicans (26.7%, 52) and Candida tropicalis (10.8%, 21). The cohort demonstrated distinctive epidemiological features: median patient age of 30 days, neonatal predominance (40.5%), and male preponderance (60%). Alarmingly high antifungal resistance profiles were observed, particularly in C. albicans (66% fluconazole and 62% voriconazole resistance) and C. dubliniensis (82% itraconazole resistance). Non-albicans infections correlated with elevated intensive care unit (ICU) admission rates and neutropenia incidence, while C. albicans cases showed stronger associations with prematurity and low birth weight. The clinical course was marked by prolonged hospitalization (median 37 days), with 56.4% requiring intensive care and 20% developing persistent candidemia. 81.5% achieved clinical resolution, though 15.4% required non-medical transfers and 3.0% succumbed to refractory infections despite maximal therapy.

CONCLUSIONS

Neonates represented the highest-risk population for pediatric fungemia, with a median hospitalization duration of 37 days. Over half of the affected children (56.4%) required ICU admission. The high rate of antifungal resistance and poor prognosis underscore the urgent need for enhanced surveillance protocols and optimized antifungal stewardship in pediatric settings.