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

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Background and Purpose: candidemia in pediatric patients. Materials and Methods: 2 Compact system. Catheter-related bloodstream infection was defined by standard criteria. Results: 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). Conclusion: 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.