EPIDEMIOLOGY AND MICROBIOLOGY OF INVASIVE CANDIDIASIS IN THE LARGEST TERTIARY GREEK PEDIATRIC HOSPITAL DURING 2008-1017.

M. Noni(1), A. Stathi(2), I. Vaki(1), L. Zachariadou(2), E. Kyrikou (2), A. Michos(1).
1National and Kapodistrian University of Athens, 1st Department of Pediatrics, Athens, Greece.
2"Aghia Sophia" Children's Hospital, Department of Clinical Microbiology, Athens, Greece.

Background
Candida species are a common cause of invasive infection in neonates and children. The aim was to study the epidemiology and microbiology of invasive candidiasis in the largest tertiary Greek pediatric hospital.

Methods
A retrospective cohort study was performed from January 2008 to December 2017. Every first Candida isolation from each episode of invasive candidiasis was included. Identification and susceptibility testing were performed according to local procedures, while antifungal susceptibility testing was performed according to CLSI methodology.

Results
During a 10-year period, 178 incidences of invasive candidiasis were recorded. Seventy-seven isolates (43.3%) were detected in neonatal intensive care units (NICU), 46 (25.8%) in pediatric clinics, 27 (15.2%) in hematology/oncology units (HOU) and 28 (15.7%) in pediatric ICU (PICU).The tissue distribution included blood (87.1%), cerebrospinal (7.9%), peritoneal  (3.9%) and pleural fluids (1.1%). Ten different Candida species were detected. Candida albicans was the most frequently isolated species (47.8%) followed by Candida parapsilosis (28.7%), Candida lusitaniae (6.2%), Candida glabrata (4.5%) and Candida tropicalis (4.5%). The resistance in fluconazole was 0.0% among C. albicans isolates and 9.6% among C. parapsilosis isolates. Interestingly, a high number of anidulafungin-resistant C. parapsilosis was noted (41.4%).

Conclusions
In our hospital, fluconazole sensitive C. albicans was the most frequently identified species  compared with C. non-albicans. High-level anidulafungin resistance among C. parapsilosis detected in our study raises serious concerns about its empirical use. Local epidemiology monitoring is always necessary to understand its burden in pediatric populations.