Clinical, Microbiological, and Outcome Characteristics of Pediatric Patients With Candidemia at the Pediatric Hospital of the National Medical Center Siglo XXI From 2022 to 2025

Introduction: Candidemia is a major healthcare-associated infection in pediatric populations, driven by invasive medical interventions and shifts in fungal epidemiology toward non-albicans Candida species. Mortality remains high worldwide, particularly in infants and critically ill children. Updated regional data from tertiary-care centers are essential to guide prevention and treatment strategies. Methods: An observational, retrospective, cross-sectional study was conducted at the Pediatric Hospital of the National Medical Center Siglo XXI (2022-2025). Patients aged 0-17 years with at least one positive blood culture for Candida spp. were included. Exclusion criteria comprised bacterial coinfection, palliative care, absence of antifungal treatment, incomplete clinical records, and diagnoses made at external institutions. Clinical characteristics, risk factors, species distribution, antifungal susceptibility, treatment, and outcomes were analyzed. Results: A total of 99 patients were evaluated, of whom 42 met the inclusion criteria. Of these, 28 (66.7%) were male patients, and the most frequent age group was infants, with 20 patients. The main risk factors were central venous catheter use in 42 patients (100%), prior antibiotic use in 39 patients (92.9%), mechanical ventilation in 35 patients (83.3%), and ICU stay in 33 patients (73.8%). Non-albicans species predominated with 34 isolates (80.9%), with Candida tropicalis being the most frequent, 14 isolates (33.3%). Resistance to fluconazole was low, one isolate (2.4%). The most commonly used treatment was fluconazole, administered to 24 patients (57.1%). In-hospital mortality was 11 patients (28.6%). Conclusion: Candidemia in this pediatric cohort was predominantly caused by non-albicans Candida species, particularly C. tropicalis. Risk factors remained strongly linked to invasive medical support and prior antibiotic exposure. Despite appropriate management, mortality remained substantial, emphasizing the need for early recognition, optimized antifungal selection, and strengthened diagnostic and susceptibility testing practices in tertiary pediatric care settings.