What question did this study set out to answer?

To analyze the epidemiology of pediatric candidemia and antifungal susceptibility profiles in children from 2016 to 2024.

June 4, 2026Open Access

Pediatric candidemia epidemiology and antifungal susceptibility profiles reported by the ISPED program in China, 2016–2024

Key Points

To analyze the epidemiology of pediatric candidemia and antifungal susceptibility profiles in children from 2016 to 2024.
Retrospective analysis of 527 pediatric candidemia cases from 13 children's hospitals in China via ISPED network.
Data collection included prevalence rates of Candida species and antifungal susceptibility measurements.
Period of study ranged from 2016 to 2024, focusing on trends in antifungal resistance.
C. parapsilosis prevalence increased significantly from 21.2% in 2019 to 51.9% in 2024 (Z=3.11, P=0.002).
C. tropicalis fluconazole susceptibility decreased from 61.5% (2016-2018) to 35.0% (2022-2024) (P<0.001).
Overall azole susceptibility in non-albicans Candida species showed a marked decline, particularly in fluconazole for C. guilliermondii.

Abstract

ABSTRACT Candidemia is life-threatening in children. Limited epidemiological and antifungal resistance data for children necessitate national surveillance. This multicenter retrospective study (2016–2024) analyzed 527 pediatric candidemia cases from 13 children’s hospitals via the Infectious Disease Surveillance of Pediatrics (ISPED) network. Candida species caused 96.0% (527/549) of fungemia cases. Neonates and infants comprised 51.6% of cases (24.5% neonates and 27.1% infants). Non -albicans Candida species (NACs) dominated (74.0%), with the prevalence of Candida parapsilosis increasing from 21.2% in 2019 to 51.9% in 2024 ( Z = 3.11, P = 0.002), while the prevalence of C. albicans decreased from 38.9% to 15.6% during the same period ( Z = −2.25, P = 0.024). Azole susceptibility of NACs decreased significantly: C. parapsilosis fluconazole susceptibility decreased from 93.5% (2016–2018) to 63.6% (2022–2024) ( P < 0.001), whereas voriconazole (79.5%–93.3%, P = 0.078) and itraconazole (80.0%–97.4%, P = 0.369) susceptibility remained high. Candida tropicalis showed low azole susceptibility, with significant decreases in susceptibility to fluconazole (61.5% in 2016–2018 to 35.0% in 2022–2024) and voriconazole (61.5% in 2016–2018 to 20.0% in 2022–2024; P < 0.001 for all). The susceptibility of wild-type Candida guilliermondii decreased toward fluconazole (100.0% in 2016–2018 and 2019–2021 to 38.9% in 2022–2024), voriconazole (100.0% in 2016–2018 and 2019–2021 to 27.8% in 2022–2024), and itraconazole (100.0% in 2016–2018 and 2019–2021 to 22.2% in 2022–2024) ( P < 0.001 for all). All Candida species showed high susceptibility to amphotericin B and echinocandins (99.0% and 95.9%, respectively). Overall, there was a notable shift toward NACs, especially C. parapsilosis , C. tropicalis , and C. guilliermondii , accompanied by declining susceptibility to azoles (particularly in C. tropicalis and C. guilliermondii ), which underscores the urgent need for enhanced antifungal stewardship and continuous resistance monitoring.

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