Pediatric yeast fungaemia species patterns, resistance profiles, and outcomes: a 20-year surveillance study in Paris, France

Background The epidemiology of pediatric yeast bloodstream infections remains poorly characterized in high-income settings despite global shifts over the past two decades. As fungal species distribution varies geographically, national surveillance is essential. In France, recent reports have focused predominantly on adults, leaving a significant evidence gap for children. Methods We analyzed data from the YEASTS program, a prospective multicentre hospital-based surveillance study conducted in 27 hospitals in the Paris area, France, between Oct 1, 2002, and Dec 31, 2022. All incident episodes of yeast bloodstream infection diagnosed during this period, were eligible. For the primary analysis, we included children and adolescents aged 6 months to 16 years; neonates and recurrent episodes were excluded. Adult cases (>16 years) recorded during the same period were included for comparison. Species identification and antifungal susceptibility testing, using EUCAST standardized method, were performed at the National Reference Center of invasive Mycoses and Antifungals (NRCMA). The primary objective was to describe the epidemiology of yeast bloodstream infections in children and adolescents and compare findings with those observed in adults (>16 years). The main outcomes assessed were species distribution, antifungal susceptibility patterns, treatment strategies, and 30-day all-cause mortality. Findings Among 346 pediatric episodes, hematological malignancy was the main underlying condition (20.5%). Candida albicans predominated (42%), although non- albicans Candida species collectively accounted for a larger proportion of episodes, notably Candida parapsilosis (23.5%) and Candida tropicalis (10%). Species distribution varied by age: younger children had more C. parapsilosis , older more Pichia kudriavzevii (syn. Candida krusei ) and Nakaseomyces glabratus (syn. Candida glabrata ). Trichosporon asahii represented 2%. Resistance rates remained low (4% to caspofungin, 8.1% fluconazole) including 4 echinocandin-resistant isolates that harbored S645P mutations in the Fks coding region. 30-day mortality was 13.5%, independently associated with C. tropicalis , N. glabratus , T. asahii , female sex, and ICU admission. Compared with 5889 adult cases, pediatric patients had a distinct species distribution, more frequent prior antifungal exposure, greater use of liposomal amphotericin B, and significantly lower adjusted 30-day mortality. Interpretation Pediatric yeast bloodstream infections exhibit distinct epidemiological characteristics, species distribution, antifungal exposure patterns, and outcomes compared with adult infections. Future research should focus on prospective age-stratified studies to better define optimal antifungal treatment strategies, evaluate the clinical significance of emerging and resistant yeast species, and identify factors associated with poor outcomes in pediatric patients. Funding Santé Publique France and Institut Pasteur.