Pediatric yeast fungaemia species patterns, resistance profiles, and outcomes: a 20-year surveillance study in Paris, France
Abstract
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.
Related
- Temporal Transitions in Dietary Patterns and Their Associations with Overweight and Obesity Among Middle-Aged and Older Adults in Southern China: Evidence from Four Rounds of Nutrition Surveillance, 2002–2022
- A Six-Year Retrospective Surveillance of Outpatient Staphylococcus aureus Resistance Dynamics in Skin and Soft Tissue Infections: Are Non-β-Lactam Options Still Reliable?
- Viral circulation patterns and hospitalisation burden of SARS-CoV-2 and influenza in the post-pandemic period: an analysis of surveillance data from the United States, England and Europe, 2022-2025
- Age-Related CT Morphometry of the Pediatric Clivus and Dorsum Sellae: Cross-Sectional Changes and Pneumatization Patterns
- Artificial intelligence–enabled nursing surveillance for pediatric cancer immunotherapy: integrating biomarkers, patient-reported outcomes, and long-term toxicity management
BibTeX
@article{albylaurent2026pediatric,
title = {{Pediatric yeast fungaemia species patterns, resistance profiles, and outcomes: a 20-year surveillance study in Paris, France}},
author = {Fanny Alby-Laurent and Thomas Obadia and Maud Gits-Muselli and Marie-Elisabeth Bougnoux and Benoit Brethon and Patricia Mariani and Juliette Guitard and Françoise Botterel and Elisabeth Chachaty and Karine Boukris-Sitbon and Alexandre Alanio and Adela Angoulvant and Nawel Ait-Ammar and Christine Bonnal and Sophie Brun and Naima Dahane and Blandine Denis and Samia Hamane and Najiby Kassis-Chikhany and Maïté Micaelo and André Paugam and Anne-Laure Roux and Olivier Lortholary and Marie Desnos-Ollivier and Fanny Lanternier},
journal = {EClinicalMedicine},
year = {2026},
month = sep,
doi = {10.1016/j.eclinm.2026.104177},
url = {https://pasteur.hal.science/pasteur-05736194v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Pediatric yeast fungaemia species patterns, resistance profiles, and outcomes: a 20-year surveillance study in Paris, France
AU - Fanny Alby-Laurent
AU - Thomas Obadia
AU - Maud Gits-Muselli
AU - Marie-Elisabeth Bougnoux
AU - Benoit Brethon
AU - Patricia Mariani
AU - Juliette Guitard
AU - Françoise Botterel
AU - Elisabeth Chachaty
AU - Karine Boukris-Sitbon
AU - Alexandre Alanio
AU - Adela Angoulvant
AU - Nawel Ait-Ammar
AU - Christine Bonnal
AU - Sophie Brun
AU - Naima Dahane
AU - Blandine Denis
AU - Samia Hamane
AU - Najiby Kassis-Chikhany
AU - Maïté Micaelo
AU - André Paugam
AU - Anne-Laure Roux
AU - Olivier Lortholary
AU - Marie Desnos-Ollivier
AU - Fanny Lanternier
PY - 2026
DA - 2026/09/02
JO - EClinicalMedicine
DO - 10.1016/j.eclinm.2026.104177
UR - https://pasteur.hal.science/pasteur-05736194v1
AB - 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.
SN - 2589-5370
ER -