Epidemiology, Species Susceptibility, and Mortality Risk Factors of Pediatric Candidemia: A 13-Year Multicenter Study

Candida species are the leading cause of invasive fungal infections in children and are associated with substantial morbidity and mortality. We conducted a multicenter retrospective study across nine hospitals in Israel, including all candidemia episodes in patients aged 0–18 years between 2010 and 2022. Clinical, microbiological, and outcome data were collected, and multivariable logistic regression was used to identify predictors of 30-day mortality. A total of 498 candidemia episodes were identified in 482 patients. Most episodes occurred in immunocompromised children or those admitted to intensive care units. Non-albicans Candida species predominated (63.3%), although C. albicans remained the single most common species (36.7%). The most frequent non-albicans species were C. parapsilosis (25.5%), C. tropicalis (15.9%), and C. glabrata (9.6%). No cases of C. auris were identified. Fluconazole non-susceptibility was observed in 19.4% of isolates and increased from 15.5% during 2010–2016 to 23.3% during 2017–2022 (OR 2.89, 95% CI 1.45–5.11, p = 0.007). The 30-day mortality rate was 23.4%. Independent predictors of mortality included liver disease, neutropenia, total parenteral nutrition, urinary tract infection, skin lesions, and peritonitis. Pediatric candidemia remains associated with considerable mortality, while increasing fluconazole non-susceptibility among non-albicans Candida species highlights the need for ongoing surveillance and antifungal stewardship.