436 - Invasive Candidiasis in Children with Hematologic Malignancies at a Quaternary Hospital

Poster Number: 436
Publication Number: 436.419

Amira M. Said, Baylor College of Medicine, Houston, TX, United States; Chelsea Daignault, Baylor College of Medicine, Houston, TX, United States; Candelaria O'Farrell, Texas Children's Hospital, Houston, TX, United States; Michael Scheurer, Baylor College of Medicine, Houston, TX, United States; Michele Redell, Baylor College of Medicine, Houston, TX, United States; Maria M. Gramatges, Texas Children's Hospital, Houston, TX, United States; Ankhi Dutta, Baylor College of Medicine, The Woodlands, TX, United States

Background: Candida species are the most common cause of invasive fungal infections in hospitalized patients. Children with hematological malignancies (HM) are at increased risk. The epidemiology of species implicated in invasive candidiasis (IC) has changed over the past 25 years with non-albicans Candida (NAC) species now prevailing. These changes have therapeutic and prophylactic implications as some species carry intrinsic resistance to widely-used antifungal medications.

Objective: We aimed to investigate local trends in IC and antifungal susceptibility patterns in this high risk group.

Design/Methods: Patients ages 0-18 with HM and at least one episode of IC from 2011-2022 were included. Patients who had received a bone marrow transplant were excluded. Information related to demographics, host factors, clinical risk factors, Candida species and antifungal minimum inhibitory concentrations (MICs), treatment and outcomes was collected via retrospective chart review. Descriptive analysis was completed with categorical variables summarized as frequencies and continuous variables summarized as means and standard deviation or medians and interquartile range.

Results: 26 cases of IC were identified, 25 of which were classified as proven. Fifty percent were males. Sixteen (62%) were Hispanic. The median age at diagnosis was 9 years (range 2 months-17 years). More than half (16/26) had B-cell acute lymphoblastic leukemia. The median time to IC from diagnosis of malignancy was 33 days (IQR 19-208). C. tropicalis (n=12; 48%) and C. glabrata (n=5; 20%) were the most common species followed by C. albicans and C. lusitaniae, which accounted for three cases each. Three of 23 patients with NAC were on a triazole preceding the infection versus 1 of 3 patients with C. albicans. Forty-six percent (11/24) had concurrent bacteremia. The most common sites of dissemination were the kidneys (n=8; 33%), lungs (n=7, 29%) and skin (n=7; 29%). Five isolates (21%) demonstrated increased MICs to fluconazole, four of which were classified as “susceptible dose-dependent” and one of which was “resistant”. Most (54%) required more than 6 weeks of antifungal therapy. Six patients died, of which three were attributed to IC.

Conclusion(s): NAC accounted for most of the IC in hematological malignancies with C.tropicalis being the most common. The implications of NAC being predominant in this high risk group is concerning due to the higher MIC to azoles and the potential for azole resistance in the future. Antifungal management both prophylaxis and treatment need to be reevaluated periodically based on these findings.