Analysis of the risk factors associated with bloodstream infections caused by Candida parapsilosis in pediatric patients and the determinants of fluconazole non-susceptibility: a retrospective 15-year cohort study

BACKGROUND: In recent decades, infections caused by C.parapsilosis have been increasingly reported, particularly strains of C.parapsilosis that are non-susceptible to fluconazole. AIMS: We aimed to evaluate candidemia episodes caused by C. parapsilosis (CP) and compare them with candidemia episodes caused by non-parapsilosis Candida spp. (non-CP). Furthermore, we examined the risk factors and outcomes of C.parapsilosis candidemia based on fluconazole susceptibility [fluconazole susceptible: FS, fluconazole non-susceptible: FNS] from January 2008 to December 2022 at Ege University. RESULTS: Of the 423 episodes of candidemia, C.parapsilosis was the most common, identified in 195 cases (46.1%). The rate of fluconazole non-susceptibility was 48.3%. Multivariate analysis indicated that fluconazole exposure and the presence of tracheostomy were significant risk factors for C. parapsilosis candidemia (32.3% vs. 18.9%; p =0.006 ; OR = 1.917; 95% CI:1.210–3.037) and (12.8% vs. 5.7%; p = 0.047; OR = 2.125 (1.010-4.469), respectively. The attributable mortality(AM) rate and crude mortality(CM) rates were slightly higher in the non-CP group than in the CP group without a significant difference (p > 0.005). Fluconazole non-susceptibility was significantly associated with antifungal exposure (p = 0.047; OR = 2.119; 95% CI = 1.012–4.437) and did not alter outcomes, including AM and CM (p > 0.05). CONCLUSIONS: This study identified significant associations between fluconazole exposure and tracheostomy with subsequent C.parapsilosis candidemia. Notably, antifungal exposure was the only clinical risk factor identified for the development of fluconazole resistance. The increasing incidence of fluconazole resistance should prompt clinicians to consider using an echinocandin in empirical therapy. CLINICAL TRIAL NUMBER: Not applicable.