Species Distribution and Antifungal Susceptibility of Candida Bloodstream Isolates in Children: A Three-Year Study From North India

BackgroundThe epidemiology of paediatric candidaemia has evolved, with non-albicans Candida (NAC) species accounting for an increasing proportion of bloodstream infections in many healthcare settings.This shift is particularly relevant in neonatal and paediatric intensive care units because antifungal susceptibility patterns vary among Candida species.This study aimed to evaluate the species distribution, antifungal susceptibility profiles and epidemiological characteristics of candidaemia at a tertiary-care paediatric hospital in northern India. MethodsThis retrospective observational study included 86 children with candidaemia, each contributing one unique bloodstream Candida isolate, between August 2018 and August 2021.Species were identified using the VITEK-2 automated identification system (bioMérieux, Marcy-l'Étoile, France) and confirmed by matrixassisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS).Antifungal susceptibility to six agents (fluconazole, voriconazole, amphotericin B, caspofungin, micafungin and flucytosine) was evaluated using VITEK-2 AST-YS07 cards and interpreted according to applicable Clinical and Laboratory Standards Institute (CLSI) M60 clinical breakpoints.Where breakpoints were unavailable, instrument-generated susceptibility categories were reported descriptively. ResultsCandidaemia was identified in 86 children among 3,440 hospital admissions (2.5 cases per 100 admissions).Neonates accounted for 58/86 children (67.4%).NAC species accounted for 70/86 isolates (81.4%; 95% CI: 71.9-88.2%),with C. pelliculosa (27/86, 31.4%) and C. parapsilosis (22/86, 25.6%) being the most frequently identified species.All 86 isolates were classified as susceptible to amphotericin B and micafungin (100%), followed by voriconazole (84/86, 97.7%), caspofungin (83/86, 96.5%), flucytosine (82/86, 95.3%) and fluconazole (72/86, 83.7%).Fluconazole non-susceptibility was reported in 14/86 isolates (16.3%), including six C. parapsilosis and two C. pelliculosa isolates.These classifications included instrument-generated categories for species-drug combinations lacking validated CLSI clinical breakpoints.No C. auris isolates were identified. ConclusionsPaediatric candidaemia at our institution was predominantly caused by NAC species, particularly C. pelliculosa and C. parapsilosis, with neonates accounting for most cases.The observed variation in fluconazole susceptibility highlights the importance of species-level identification and institution-specific antifungal susceptibility surveillance.However, automated susceptibility classifications should be interpreted cautiously for species-drug combinations lacking validated clinical breakpoints.