Liliwe Shuping1, Ruth Mpembe1, Mabatho Mhlanga1,2, Serisha D Naicker1,3, Tsidiso G Maphanga1,3, Ernest Tsotetsi1, Jeannette Wadula3,4, Sithembiso Velaphi5, Firdose Nakwa5, Vindana Chibabhai3,6, Prasha Mahabeer7,8, Masego Moncho9, Elizabeth Prentice10,11, Colleen Bamford12, Kessendri Reddy12, Caroline Maluleka13,14, Dini Mawela13,14, Motshabi Modise15, Nelesh P Govender1,3. 1. From the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa. 2. School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa. 3. Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. 4. Department of Microbiology, National Health Laboratory Service, Chris Hani Baragwanath Hospital, Johannesburg, South Africa. 5. Department of Paediatrics and Child Health, Chris Hani Baragwanath Hospital, Johannesburg, South Africa. 6. Department of Microbiology, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa. 7. Department of Microbiology, National Health Laboratory Service, King Edward VIII Hospital, KZN Academic Complex, Durban, South Africa. 8. Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. 9. Department of Medical Microbiology, Faculty of Health Sciences, Universitas Hospital, National Health Laboratory Service, University of Free State, Bloemfontein, South Africa. 10. Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. 11. Groote Schuur Microbiology Laboratory, National Health Laboratory Service, Cape Town, South Africa. 12. Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University/National Health Laboratory Services, Tygerberg, Cape Town, South Africa. 13. Department of Microbiology, National health Laboratory Service, Dr George Mukhari Hospital, Johannesburg, South Africa. 14. Department of Paediatrics and Child Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa. 15. Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a Division of National Health Laboratory Service, Johannesburg, South Africa.
Abstract
BACKGROUND: We aimed to describe the epidemiology of candidemia among children in South Africa. METHODS: We conducted laboratory-based surveillance among neonates (≤28 days), infants (29 days to <1 year), children (1-11 years) and adolescents (12-17 years) with Candida species cultured from blood during 2012-2017. Identification and antifungal susceptibility of viable isolates were performed at a reference laboratory. We used multivariable logistic regression to determine the association between Candida parapsilosis candidemia and 30-day mortality among neonates. RESULTS: Of 2996 cases, neonates accounted for 49% (n = 1478), infants for 27% (n = 806), children for 20% (n = 589) and adolescents for 4% (n = 123). The incidence risk at tertiary public sector hospitals was 5.3 cases per 1000 pediatric admissions (range 0.39-119.1). Among 2943 cases with single-species infections, C. parapsilosis (42%) and Candida albicans (36%) were most common. Candida auris was among the 5 common species with an overall prevalence of 3% (n = 47). Fluconazole resistance was more common among C. parapsilosis (55% [724/1324]) versus other species (19% [334/1737]) (P < 0.001). Of those with known treatment (n = 1666), 35% received amphotericin B deoxycholate alone, 32% fluconazole alone and 30% amphotericin B deoxycholate with fluconazole. The overall 30-day in-hospital mortality was 38% (n = 586) and was highest among neonates (43% [323/752]) and adolescents (43% [28/65]). Compared with infection with other species, C. parapsilosis infection was associated with a reduced mortality among neonates (adjusted odds ratio 0.41, 95% confidence interval: 0.22-0.75, P = 0.004). CONCLUSIONS: Candidemia in this setting mainly affected neonates and infants and was characterized by fluconazole-resistant C. parapsilosis with no increased risk of death.
BACKGROUND: We aimed to describe the epidemiology of candidemia among children in South Africa. METHODS: We conducted laboratory-based surveillance among neonates (≤28 days), infants (29 days to <1 year), children (1-11 years) and adolescents (12-17 years) with Candida species cultured from blood during 2012-2017. Identification and antifungal susceptibility of viable isolates were performed at a reference laboratory. We used multivariable logistic regression to determine the association between Candida parapsilosis candidemia and 30-day mortality among neonates. RESULTS: Of 2996 cases, neonates accounted for 49% (n = 1478), infants for 27% (n = 806), children for 20% (n = 589) and adolescents for 4% (n = 123). The incidence risk at tertiary public sector hospitals was 5.3 cases per 1000 pediatric admissions (range 0.39-119.1). Among 2943 cases with single-species infections, C. parapsilosis (42%) and Candida albicans (36%) were most common. Candida auris was among the 5 common species with an overall prevalence of 3% (n = 47). Fluconazole resistance was more common among C. parapsilosis (55% [724/1324]) versus other species (19% [334/1737]) (P < 0.001). Of those with known treatment (n = 1666), 35% received amphotericin B deoxycholate alone, 32% fluconazole alone and 30% amphotericin B deoxycholate with fluconazole. The overall 30-day in-hospital mortality was 38% (n = 586) and was highest among neonates (43% [323/752]) and adolescents (43% [28/65]). Compared with infection with other species, C. parapsilosis infection was associated with a reduced mortality among neonates (adjusted odds ratio 0.41, 95% confidence interval: 0.22-0.75, P = 0.004). CONCLUSIONS: Candidemia in this setting mainly affected neonates and infants and was characterized by fluconazole-resistant C. parapsilosis with no increased risk of death.
Authors: Danilo Y Thomaz; Gilda M B Del Negro; Leidiane B Ribeiro; Mirian da Silva; Gabrielle O M H Carvalho; Carlos H Camargo; João N de Almeida; Adriana L Motta; Rinaldo F Siciliano; Odeli N E Sejas; Flávia Rossi; Edson Abdala; Tânia M V Strabelli; Gil Benard Journal: J Fungi (Basel) Date: 2022-01-20