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

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 an 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, 36 out of 205 patients (17.6%) were positive for fungemia. 32 (88.9%) and 4 (11.1%) cases were found to be caused by Candida and Rhodotorula species, respectively. The patient's age ranged from 1 to 14 years. The majority of the patients were males (28; 77.8%) and were hospitalized for more than seven days (33; 91.7%). Non-Candida albicans species were the most common agents of fungemia (27 patients; 75%), with C. parapsilosis (77.8 %) 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. Conclusions: 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, maybe 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.