Species distribution and antifungal susceptibility patterns of Candida involvement in pediatric solid organ transplant recipients: A cross-sectional study from a single transplant center

Abstract

The epidemiology and resistance patterns of Candida infections in pediatric kidney/liver recipients has not been well characterized, recently. In this study, all patients ≤ 18 years old who underwent liver/kidney transplant surgery between September 2021 and 2022 were included. Species identification of isolates recovered from clinical specimens was performed by DNA-sequencing method following amplification of the ITS1–5.8S–ITS2 regions. Antifungal susceptibility patterns of isolates were performed using the micro broth dilution method documented by Clinical & Laboratory Standards Institute (CLSI) guidelines. Of the 117 pediatric recipients enrolled, 16 recipients (13.7 %) had at least one positive Candida culture. Candidemia was detected in 5/89 (5.6 %) of liver and 1/28 (3.6 %) of kidney transplant recipients. Invasive candidiasis was observed in 6/89 (6.7 %) of liver and 2/28 (7.1 %) of kidney transplant recipients. The predominant species was Candida (C.) albicans recovered from 12 of 16 recipients (75 %). In addition to the Pichia kudriavzevii species with inherent resistance to fluconazole, one of C. albicans isolates and one C. tropicalis isolate were also identified as fluconazole-resistant (3/29:10.3 %). Moreover, our findings revealed 13.8 % and 6.8 % resistance to itraconazole and voriconazole, respectively. All Candida spp. were susceptible to caspofungin. Collectively, this study provides valuable insights into the epidemiology and resistance patterns of Candida infections in pediatric kidney and liver recipients. The study also highlights the emergence of fluconazole-resistant strains, which has significant implications for antifungal stewardship efforts in pediatric transplant populations.