Breakthrough candidemia in children: Clinical and microbiological characteristics, therapeutic strategies and impact on outcomes

Aim: To assess the characteristics, treatments, risk factors and outcomes of breakthrough candidemia in children. Materials & methods: Episodes of breakthrough candidemia in children were compared with the remaining episodes in a 13-year cohort study. Results: Out of 319 episodes, 45 (14.1%) were breakthrough candidemia. Breakthrough candidemia occurred in patients with more acutely ill conditions, and the majority was caused by non-albicans Candida species (73.3%; 33 episodes). A total of 79.1% of breakthrough candidemia were caused by antifungal-susceptible Candida isolates and emergence of resistance was the mechanism in five cases of patients receiving fluconazole. Episodes of breakthrough candidemia had significantly higher illness severity and higher rates of fungemia-attributable mortality. Conclusion: Breakthrough candidemia independently contributed to unfavorable outcomes, and more aggressive treatment strategies are warranted when breakthrough candidemia is encountered.