Epidemiological and Antifungal Susceptibility Aspects of Fungemia Agents in Pediatric Patients with Hematological Malignancies: A Single-Center Experience

authors:

avatar Ali Amin Asnafi ORCID 1 , avatar Maryam Moslem ORCID 2 , 3 , avatar Fatemeh Sarbandi ORCID 1 , 4 , avatar Sadegh Khodavaisy ORCID 5 , 6 , avatar Neda Kiasat ORCID 7 , 8 , *

Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Pharmacognosy, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Pediatrics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran Iran
Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran Iran
Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Jundishapur Journal of Microbiology: Vol.17, issue 6; e148274
published online: July 24, 2024
article type: Research Article
revised: July 03, 2024
DOI: https://doi.org/10.5812/jjm-148274

how to cite: Asnafi A A, Moslem M, Sarbandi F, Khodavaisy S, Kiasat N. Epidemiological and Antifungal Susceptibility Aspects of Fungemia Agents in Pediatric Patients with Hematological Malignancies: A Single-Center Experience. Jundishapur J Microbiol. 2024;17(6):e148274. https://doi.org/10.5812/jjm-148274.

Abstract

Background: Fungemia is a life-threatening infection which requires an early diagnosis and use of appropriate antifungal agents to be treated effectively. Objectives: Here, we describe the clinical-epidemiological characteristics as well as the antifungal susceptibility patterns of fungal agents in pediatric patients with malignancy. 
Methods: Two hundred and five blood samples were cultured to detect infection. The infectious agents were identified by phenotypic methods and 21-plex PCR. Antifungal susceptibility testing was performed using E-test and disc diffusion test based on CLSI standard M27-A3 protocol. The demographic data of the studied population were extracted and analyzed. 
Results: In total, 37 out of 205 patients (18.1%) were positive for fungemia. 32 (86.5%), 4 (10.8%), and 1 (2.7%) case were found to be caused by Candida, Rhodotorula, and Wickerhamomyces species, respectively. The patient age ranged from 1 to 14 years. The majority of the patients were males (29; 78.4%) hospitalized for more than seven days (34; 91.8%). Non-C. albicans species were the most common agents of fungemia (27 patients; 72.9%) with C. parapsilosis (84%) as the dominant agent. Fever, central venous catheters, and broad-spectrum antibiotic therapy were observed in all cases. Itraconazole resistance was observed in a species of C. orthopsilosis. While the Candida isolates were susceptible to fluconazole, C. parapsilosis showed a significant rate of resistance to caspofungin, followed by itraconazole and amphotericin B. Overall, no mortality was reported among the fungemia cases. 
Conclusion: This study identified acute lymphoblastic leukemia (ALL) as a hematologic malignancy associated with fungemia. The increase of non-C. albicans species, including C. parapsilosis, along with reduced susceptibility to antifungal drugs may be a warning sign in pediatric patients with malignancies. Furthermore, fluconazole was the most effective antifungal agent against the recovered isolates. Therefore, the best strategy for the management of fungemia is to increase knowledge based on local epidemiological and mycological characteristics.