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This study aimed to identify the antifungal susceptibility of colonized <jats:italic>Candida<\/jats:italic> species isolated from pediatric patients with cancer and evaluate the clinical impact of antifungal stewardship (AFS) interventions on the antifungal susceptibility of colonized <jats:italic>Candida<\/jats:italic> species. <jats:italic>Candida<\/jats:italic> species colonization was evaluated among hospitalized children with cancer in a tertiary teaching hospital, Shiraz 2017\u20132018. Samples were collected from the mouth, nose, urine, and stool of the patients admitted to our center and cultured on sabouraud dextrose agar. The isolated yeasts identified by polymerase chain reaction\u2013restriction fragment length polymorphisms (PCR\u2013RFLP). DNA Extracted and PCR amplification was performed using the ITS1 and ITS4 primer pairs and Msp I enzyme. The broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) for amphotericin B, caspofungin, and azoles. The prevalence of <jats:italic>Candida albicans<\/jats:italic> in the present study was significantly higher than other <jats:italic>Candida<\/jats:italic> species. <jats:italic>Candida albicans<\/jats:italic> species were completely susceptible to the azoles. The susceptibility rate of <jats:italic>C. albicans<\/jats:italic> to amphotericin B and caspofungin was 93.1% and 97.1%, respectively. The fluconazole MIC values of <jats:italic>Candida albicans<\/jats:italic> decreased significantly during the post-AFS period (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001; mean difference: 72.3; 95% CI of the difference: 47.36\u201398.62). We found that \u200f52.5% (53\/117) of the isolated <jats:italic>C. albicans<\/jats:italic> were azole-resistant before AFS implementation, while only 1.5% (2\/102) of the isolates were resistant after implementation of the AFS program (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). <jats:italic>C. albicans<\/jats:italic> fluconazole and caspofungin resistant rate also decreased significantly (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) after implementation of the AFS program [26 (32.9%) versus 0 (0.0%) and 11 (10.9%) versus 1 (0.9%), respectively]. Besides, fluconazole use (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) and fluconazole expenditure reduced significantly (about one thousand US$ per year) after the AFS program. Our results confirm the positive effect of optimized antifungal usage and bedside intervention on the susceptibility of <jats:italic>Candida<\/jats:italic> species after the implementation of the AFS program. <jats:italic>C. albicans<\/jats:italic> and <jats:italic>C. glabrata<\/jats:italic> exhibited a significant increase in susceptibility after the execution of the AFS program.<\/jats:p>","DOI":"10.1038\/s41598-021-93421-3","type":"journal-article","created":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T10:04:40Z","timestamp":1625738680000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy"],"prefix":"10.1038","volume":"11","author":[{"given":"Ali","family":"Amanati","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parisa","family":"Badiee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadis","family":"Jafarian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatemeh","family":"Ghasemi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samane","family":"Nematolahi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sezaneh","family":"Haghpanah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seyedeh Sedigheh","family":"Hamzavi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"key":"93421_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1111\/j.1469-0691.2008.01978.x","volume":"14","author":"M Richardson","year":"2008","unstructured":"Richardson, M. & Lass Fl\u00f6rl, C. 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