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Background  Surveillance of current changes in the epidemiology of  Invasive Fungal Diseases  (IFDs) as an important component of the antifungal stewardship programs (ASP), requires careful regular monitoring, especially in high-risk settings such as oncology centers. This study aimed to examine  Candida  colonization status and corresponding current changes in children with malignancy during repeated admissions and also investigate the possible epidemiological shifts after the implementation of ASP.    Methods  In this prospective observational study, all eligible patients younger than 18 years were recruited during 2016–2017 at  Amir Medical Oncology Center  (AMOC) in Shiraz, Iran. Totally, 136 patients were enrolled and 482 samples were collected from different sites (oral/nasal discharges, urine and stool). Weekly regular sampling was carried out during hospitalization.  Candida  colonization status and epidemiological changes were monitored during repeated admissions. Samples were cultivated on Sabouraud Dextrose agar medium and identified by Polymerase Chain Reaction -Restriction Fragment Length Polymorphism (PCR-RFLP).    Results  Estimated  Candida  colonization incidence was 59.9% (82/136) in our patients.  Candida  colonization was found to be higher in oral cavity and rectum than that in nasal cavity. Among those long-term follow ups and repetitive hospitalizations, a significant number of patients exhibited changes in their colonization patterns (37.7%).  Candida  colonization did not reveal any significant relationship with age, sex, oncologic diseases and degree of neutropenia.  C. albicans  (72.0%) was found as the most common  Candida  species in colonized patients, followed by  C. krusei ,  C. kefyr ,  C. glabrata  and  C. parapsilosis .    Conclusion  Given the high incidence of  Candida  infections in children with cancers, close monitoring of epidemiologic changes is essential for judicious management, based on local surveillance data and improvement of overall quality of care in high risk patients.

bmc infectious diseases

Changing face of Candida colonization pattern in pediatric patients with hematological malignancy during repeated hospitalizations, results of a prospective observational study (2016–2017) in shiraz, Iran