Acta Scientific Paediatrics (ISSN: 2581-883X)

Research Article Volume 3 Issue 11

Comparative Analysis of Candida albicans Versus Candida Non-albicans Infection among Pediatric Patients at King Abdulaziz University Hospital

Khouloud Abdulrhman Al-Sofyani1*, Mohammed Shahab Uddin2, Huda Saeed Alghamdi3 and Dalia El-Hossary4,5

1Department of Pediatric, Pediatric Intensive Critical Care Unit, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
2Department of Pediatric, Pediatric Intensive Critical Care Unit, National Guard Health Affairs, Dammam, Kingdom of Saudi Arabia
3Consultant Medical Microbiology, Clinical and Molecular Microbiological Laboratory, Faculty of Medicine and Medical Microbiology, King Abdulaziz Hospital, Jeddah, Kingdom of Saudi Arabia
4Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt
5Clinical and Molecular Microbiological Laboratory, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia

*Corresponding Author: Khouloud Abdulrhman Al-Sofyani, Department of Pediatric, Pediatric Intensive Critical Care Unit, King Abdulaziz University, Jeddah, Saudi Arabia.

Received: September 25, 2020; Published: October 28, 2020



Background : Candidemia is one of the major causes of morbidity and mortality among critically ill pediatric patients. This study aimed to determine the prevalence of Candida infection, different strains, associated risk factors, and outcomes in critically ill patients with candidemia.

Method: Critically ill pediatric patients with invasive candidiasis were included in this retrospective study. Patients were 14 years or younger, admitted to King Abdulaziz University Hospital from March 2018 to February 2020.

Results: Out of 61 pediatric patients cases with candidemia, 23 (37.7%) patients were diagnosed with C. albicans and 38 (62.3%) with non-albicans. Species present in non-albicans Candida group included Candida parapsilosis 15 (24.6%), Candida topicalis 12 (19.7%) and Candida glabrata 4 (6.6%). Majority Candida strains were sensitive to antifungals. The main admitting diagnosis was sepsis 21 (34.4%) and the main isolation site of Candida species was blood. The main risk factors and predictors of candidemia were age younger than 5 months, presence of a central venous catheter, urinary catheter, using TPN, and blood products transfusion. Finally, the number of mortalities and length of ICU stay was higher among C. albicans patients, whereas the duration of hospitalization, broad-spectrum antimicrobial and antifungal treatment, were higher among C. non-albicans infected patients.

Conclusion: Although C. albicans infection cases are still dominant, however, the number of cases due to C. non-albicans infection is high. The study also highlighted some of the indicators that may help in early prophylactic intervention, which in turn can help improve the poor clinical prognostic outcome in Saudi Arabia.

Keywords: Candidemia; Candida albicans; Candida non-albicans; Risk Factors; Outcome



  1. Guinea J. “Global trends in the distribution of Candida species causing candidemia”. Clinical Microbiology and Infection6 (2014): 5-10.
  2. Martin GS., et al. “The epidemiology of sepsis in the United States from 1979 through 2000”. The New England Journal of Medicine16. (2003): 1546-1554.
  3. Lepak A and Andes D. “Fungal sepsis: optimizing antifungal therapy in the critical care setting”. Critical Care Clinics1 (2011): 123-147.
  4. Kaushik A and Kest H. “The role of antifungals in pediatric critical care invasive fungal infections”. Critical Care Research and Practice (2018): 8469585.
  5. Hawksworth DL. “The magnitude of fungal diversity: the 1.5 million species estimate revisited”. Mycological Research12 (2001): 1422-1432.
  6. Pfaller MA and Diekema DJ. “Epidemiology of invasive candidiasis: a persistent public health problem”. Clinical Microbiology Reviews1 (2007): 133-163.
  7. Mesini A., et al. “Candida infections in paediatrics: Results from a prospective single-centre study in a tertiary care children's hospital”. Mycoses2 (2017): 118-123.
  8. Playford EG., et al. “Prophylaxis, empirical and preemptive treatment of invasive candidiasis”. Current Opinion in Critical Care5 (2010): 470-474.
  9. Doi AM., et al. “Epidemiology and microbiologic characterization of nosocomial candidemia from a brazilian national surveillance program”. PloS one1 (2016): e0146909.
  10. Pfaller MA., et al. “Results from the ARTEMIS DISK Global Antifungal Surveillance study, 1997 to 2005: an 8.5-year analysis of susceptibilities of Candida species and other yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing”. Journal of Clinical Microbiology6 (2007): 1735-1745.
  11. Colombo AL., et al. “Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: an analysis of five multicenter studies sequentially conducted over a 9-year period”. Intensive Care Medicine10 (2014): 1489-1498.
  12. Ahmed A., et al. “Risk prediction for invasive candidiasis”. Indian Journal of Critical Care Medicine10 (2014): 682-688.
  13. Delaloye J and Calandra T. “Invasive candidiasis as a cause of sepsis in the critically ill patient”. Virulence1 (2014): 161-169.
  14. Almooosa Z., et al. “Invasive Candidiasis in pediatric patients at King Fahad Medical City in Central Saudi Arabia. A 5-year retrospective study”. Saudi Medical Journal11 (2017): 1118-1124.
  15. Lortholary O., et al. “Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002-2010)”. Intensive Care Medicine9 (2014): 1303-1312.
  16. Bassetti M., et al. “A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality”. Intensive Care Medicine6 (2014): 839-845.
  17. Falagas ME., et al. “Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review”. International Journal of Infectious Diseases11 (2010): e954-966.
  18. Falagas ME., et al. “Attributable mortality of candidemia: a systematic review of matched cohort and case-control studies”. European Journal of Clinical Microbiology and Infectious Diseases7 (2006): 419-425.
  19. Gudlaugsson O., et al. “Attributable mortality of nosocomial candidemia, revisited”. Clinical Infectious Diseases9 (2003): 1172-1177.
  20. Zaoutis TE., et al. “The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis”. Clinical Infectious Diseases9 (2005): 1232-1239.
  21. Colombo AL., et al. “Candida glabrata: an emerging pathogen in Brazilian tertiary care hospitals”. Medical Mycology1 (2013): 38-44.
  22. Nucci M., et al. “Epidemiology of opportunistic fungal infections in Latin America”. Clinical Infectious Diseases5 (2010): 561-570.
  23. Abi-Said D., et al. “The epidemiology of hematogenous candidiasis caused by different Candida species”. Clinical Infectious Diseases6 (1997): 1122-1128.
  24. Pfaller MA., et al. “Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the Prospective Antifungal Therapy (PATH) registry 2004-2008”. PloS one7 (2014): e101510.
  25. Chowdhary A., et al. “Multidrug-resistant endemic clonal strain of Candida auris in India”. European Journal of Clinical Microbiology and Infectious Diseases6 (2014): 919-926.
  26. Pfaller MA., et al. “Variation in Candida spp. distribution and antifungal resistance rates among bloodstream infection isolates by patient age: report from the SENTRY Antimicrobial Surveillance Program (2008-2009)”. Diagnostic Microbiology and Infectious Disease3 (2010): 278-283.
  27. Cuenca-Estrella M., et al. “Activity profile in vitro of micafungin against Spanish clinical isolates of common and emerging species of yeasts and molds”. Antimicrobial Agents and Chemotherapy5 (2009): 2192-2195.
  28. Pfaller MA., et al. “Geographic variations in species distribution and echinocandin and azole antifungal resistance rates among Candida bloodstream infection isolates: report from the SENTRY Antimicrobial Surveillance Program (2008 to 2009)”. Journal of Clinical Microbiology1 (2011): 396-399.
  29. Arendrup MC and Perlin DS. “Echinocandin resistance: an emerging clinical problem?”. Current Opinion in Infectious Diseases6 (2014): 484-492.
  30. Souza AC., et al. “Candida parapsilosis resistance to fluconazole: Molecular mechanisms and in vivo impact in infected galleria mellonella larvae”. Antimicrobial Agents and Chemotherapy10 (2015): 6581-6587.
  31. Castanheira M., et al. “Activity of echinocandins and triazoles against a contemporary (2012) worldwide collection of yeast and moulds collected from invasive infections”. International Journal of Antimicrobial Agents4 (2014): 320-326.
  32. Pappas PG., et al. “Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America”. Clinical Infectious Diseases4 (2016): e1-50.
  33. Al Thaqafi AH., et al. “Predictors and outcomes of Candida bloodstream infection: eight-year surveillance, western Saudi Arabia”. International Journal of Infectious Diseases (2014): 5-9.
  34. Guery BP., et al. “Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment”. Intensive Care Medicine2 (2009): 206-214.
  35. Guery BP., et al. “Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part I. Epidemiology and diagnosis”. Intensive Care Medicine1 (2009): 55-62.
  36. Seng P., et al. “Ongoing revolution in bacteriology: routine identification of bacteria by matrix-assisted laser desorption ionization time-of-flight mass spectrometry”. Clinical Infectious Diseases4 (2009): 543-551.
  37. Kmeid J., et al. “Epidemiology and burden of invasive fungal infections in the countries of the Arab League”. Journal of Infection and Public Health (2019).
  38. Alothman AF., et al. “Burden and treatment patterns of invasive fungal infections in hospitalized patients in the Middle East: real-world data from Saudi Arabia and Lebanon”. Infection and Drug Resistance (2017): 35-41.
  39. Alothman AF., et al. “Clinical practice guidelines for the management of invasive Candida infections in adults in the Middle East region: Expert panel recommendations”. Journal of Infection and Public Health1 (2014): 6-19.
  40. Kim A., et al. “Hospital costs and outcomes among intravenous antifungal therapies for patients with invasive aspergillosis in the United States”. Mycoses5 (2011): e301-12.
  41. Webb BJ., et al. “Epidemiology and clinical features of invasive fungal infection in a US health care network”. Open Forum Infectious Diseases8 (2018): ofy187.
  42. Enoch DA., et al. “Invasive fungal infections: a review of epidemiology and management options”. Journal of Medical Microbiology7 (2006): 809-818.
  43. Horn DL., et al. “Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry”. Clinical Infectious Diseases12 (2009): 1695-1703.
  44. Palazzi DL., et al. “Candida speciation, antifungal treatment and adverse events in pediatric invasive candidiasis: results from 441 infections in a prospective, multi-national study”. The Pediatric Infectious Disease Journal12 (2014): 1294-1296.
  45. Dutta A and Palazzi DL. “Candida non-albicans versus Candida albicans fungemia in the non-neonatal pediatric population”. The Pediatric Infectious Disease Journal8 (2011): 664-668.
  46. Montagna MT., et al. “Candidemia in intensive care unit: a nationwide prospective observational survey (GISIA-3 study) and review of the European literature from 2000 through 2013”. European Review for Medical and Pharmacological Sciences5 (2014): 661-674.
  47. Chow JK., et al. “Factors associated with candidemia caused by non-albicans Candida species versus Candida albicans in the intensive care unit”. Clinical Infectious Diseases 8 (2008): 1206-1213.
  48. Playford EG., et al. “Candidemia in nonneutropenic critically ill patients: risk factors for non-albicans Candida spp”. Critical Care Medicine7 (2008): 2034-2039.
  49. Bassetti M., et al. “Epidemiological trends in nosocomial candidemia in intensive care”. BMC Infectious Diseases (2006): 21.
  50. Wisplinghoff H., et al. “Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features and susceptibilities”. The Pediatric Infectious Disease Journal8 (2003): 686-691.
  51. Watson RS., et al. “The epidemiology of severe sepsis in children in the United States”. American Journal of Respiratory and Critical Care Medicine5 (2003): 695-701.
  52. Pfaller MA., et al. “Trends in antifungal susceptibility of Candida spp. isolated from pediatric and adult patients with bloodstream infections: SENTRY Antimicrobial Surveillance Program, 1997 to 2000”. Journal of Clinical Microbiology3 (2002): 852-856.
  53. Krcmery V., et al. “Aetiology, antifungal susceptibility, risk factors and outcome in 201 fungaemic children: data from a 12-year prospective national study from Slovakia”. Journal of Medical Microbiology2 (2002): 110-116.
  54. Hope WW., et al. “Population pharmacokinetics of micafungin in pediatric patients and implications for antifungal dosing”. Antimicrobial Agents and Chemotherapy10 (2007): 3714-3719.
  55. Blyth CC., et al. “Not just little adults: candidemia epidemiology, molecular characterization, and antifungal susceptibility in neonatal and pediatric patients”. Pediatrics5 (2009): 1360-1368.
  56. Zaoutis TE., et al. “Risk factors for mortality in children with candidemia”. The Pediatric Infectious Disease Journal8 (2005): 736-739.
  57. Singhi SC., et al. “Candidemia in a pediatric intensive care unit”. Pediatric Critical Care Medicine4 (2004): 369-374.
  58. Zaoutis TE., et al. “Risk factors and predictors for candidemia in pediatric intensive care unit patients: implications for prevention”. Clinical Infectious Diseases5 (2010): e38-45.
  59. Omrani AS., et al. “Ten-year review of invasive Candida infections in a tertiary care center in Saudi Arabia”. Saudi Medical Journal8 (2014): 821-826.
  60. Dimopoulos G., et al. “Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome”. Anesthesia and Analgesia2 (2008): 523-529.
  61. Holley A., et al. “Temporal trends, risk factors and outcomes in albicans and non-albicans candidaemia: an international epidemiological study in four multidisciplinary intensive care units”. International Journal of Antimicrobial Agents6 (2009): 554.e1-554.e7.
  62. Montagna MT., et al. “Epidemiology of invasive fungal infections in the intensive care unit: results of a multicenter Italian survey (AURORA Project)”. Infection3 (2013): 645-653.


Citation: Khouloud Abdulrhman Al-Sofyani., et al. "Comparative Analysis of Candida albicans Versus Candida Non-albicans Infection among Pediatric Patients at King Abdulaziz University Hospital". Acta Scientific Paediatrics 3.11 (2020): 37-47.


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