Systemic fungal infection is still an important cause of mortality through health care associated infections (HCAI) in children. The management of this pathology it is more difficult as the age is lower, the nutritional and immune status affected, the associated pathology is severe with vital risk and the sensitivity to the common antifungals compromised. Aim: identification the incidence of fungal sepsis in HCAI, risk factor and therapeutic management difficulties to them.Method: retrospective study of 982 cases of HCAI during the period 2012-2017 at the Emergency Hospital for Children Iasi, from which 53 cases (21,58%) of Candida albicans and non-albicans infection were identified, out of which 18 cases (33, 96%) with sepsis (blood culture by Backton-Dickinson system).
Results: age group: <1 month -50% of which premature-33.33%, 1-11 months-22.22%, 1-4 years -16.66%, 5-10 years -11.11%; clinical areas: neonatal intensive care unit  (ICU) - 50%, paediatric ICU-22.22%, pediatric surgery-16.66%, oncology - 11.11%; associated diseases: malnutrition -55.55%, renal disease with hemodialysis-11.11%, malformations with various localizations- 66.66%, oncologic disease- 11.11%, pulmonary infection-16.61%, infectious endocarditis-16,61%, total parenteral nutrition-61,11%; invasive medical device: mechanical ventilation- 44 44%;  venous central catheter-66,66%; length of stay (days)in the ICU: >14-72,22%; <14-27,78%;  etiology: Candida albicans-61,11%, non-albicans (parapsilosis; tropicalis) -27,77%, Trichosporon beigelii-5,55%, Rhodotorula mucilaginosa; pure candidemia -72,22%, mixed candidemia and bacteriemia-27,78%; sensitivity spectrum: Candida albicans: only Amphotericin B (Amf B) and 5 fluorocytosine; non-albicans: azole derivates (Fluconazol, Voriconazol, Itraconazol), Amf B, Caspofungin, Mycafungin, Anidulafungin. Conclusions: Management of fungal sepsis remains a challenge by correctly assessing the timing and type of treatment appropriate to age and associated pathology, directly influencing the mortality rate.

DIFFICULTIES IN THE MANAGEMENT OF INVASIVE FUNGAL INFECTION IN CHILDREN