Oral Candida infection and colonization in pediatric patients with cancer: risk factors, species distribution, and antifungal susceptibility.

BACKGROUND

Oral candidiasis is a common opportunistic fungal infection in pediatric cancer patients, which can lead to severe invasive infections. To manage and treat oral candidiasis effectively, it is vital to address risk factors, accurately identify Candida species, and provide suitable topical or systemic antifungal therapy.

METHODS

This study included all patients aged ≤ 18 years with cancer from April to September 2024. Oral examinations were conducted along with the collection of microbial swabs. Species identification was performed using both conventional and molecular methods. The in vitro antifungal activity of six common agents was investigated using the Clinical & Laboratory Standards Institute guidelines.

RESULTS

Of the 102 pediatric patients with cancer, 39 (38.2%) had positive cultures. Among those with a positive culture, 9 patients (23.1%) were diagnosed with oral candidiasis, while 30 (76.9%) exhibited oral Candida colonization. No statistically significant link was found between age or gender and oral candidiasis, while dexamethasone and ceftazidime were significantly associated. Among 41 obtained Candida isolates, C. albicans was the most common (51.2%), followed by C. dubliniensis (21.9%), C. africana (12.1%), C. tropicalis (7.3%), N. glabratus (2.4%), K. marxianus (2.4%), and P. kudriavzevii (2.4%). Amphotericin B and caspofungin demonstrated the highest in vitro activity against all Candida isolates. Fluconazole showed the highest resistance rate at 28.6% for C. albicans.

CONCLUSION

This study provides valuable insights into risk factors, molecular epidemiology, and antifungal susceptibility patterns associated with oral Candida colonization and infection in pediatric cancer patients. It also underscores the importance of continued surveillance of antifungal susceptibility patterns to support antifungal stewardship efforts in this population.