{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:08:30Z","timestamp":1785409710357,"version":"3.56.0"},"reference-count":28,"publisher":"American Society for Microbiology","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["NO.82202567"],"award-info":[{"award-number":["NO.82202567"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Key Development Program of Children's Hospital of Fudan University","award":["EK2022ZX05"],"award-info":[{"award-number":["EK2022ZX05"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Candidemia is life-threatening in children. Limited epidemiological and antifungal resistance data for children necessitate national surveillance. This multicenter retrospective study (2016\u20132024) analyzed 527 pediatric candidemia cases from 13 children\u2019s hospitals via the Infectious Disease Surveillance of Pediatrics (ISPED) network.\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species caused 96.0% (527\/549) of fungemia cases. Neonates and infants comprised 51.6% of cases (24.5% neonates and 27.1% infants). Non\n                      <jats:italic toggle=\"yes\">-albicans Candida<\/jats:italic>\n                      species (NACs) dominated (74.0%), with the prevalence of\n                      <jats:italic toggle=\"yes\">Candida parapsilosis<\/jats:italic>\n                      increasing from 21.2% in 2019 to 51.9% in 2024 (\n                      <jats:italic toggle=\"yes\">Z<\/jats:italic>\n                      = 3.11,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002), while the prevalence of\n                      <jats:italic toggle=\"yes\">C. albicans<\/jats:italic>\n                      decreased from 38.9% to 15.6% during the same period (\n                      <jats:italic toggle=\"yes\">Z<\/jats:italic>\n                      = \u22122.25,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.024). Azole susceptibility of NACs decreased significantly:\n                      <jats:italic toggle=\"yes\">C. parapsilosis<\/jats:italic>\n                      fluconazole susceptibility decreased from 93.5% (2016\u20132018) to 63.6% (2022\u20132024) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), whereas voriconazole (79.5%\u201393.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.078) and itraconazole (80.0%\u201397.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.369) susceptibility remained high.\n                      <jats:italic toggle=\"yes\">Candida tropicalis<\/jats:italic>\n                      showed low azole susceptibility, with significant decreases in susceptibility to fluconazole (61.5% in 2016\u20132018 to 35.0% in 2022\u20132024) and voriconazole (61.5% in 2016\u20132018 to 20.0% in 2022\u20132024;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001 for all). The susceptibility of wild-type\n                      <jats:italic toggle=\"yes\">Candida guilliermondii<\/jats:italic>\n                      decreased toward fluconazole (100.0% in 2016\u20132018 and 2019\u20132021 to 38.9% in 2022\u20132024), voriconazole (100.0% in 2016\u20132018 and 2019\u20132021 to 27.8% in 2022\u20132024), and itraconazole (100.0% in 2016\u20132018 and 2019\u20132021 to 22.2% in 2022\u20132024) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001 for all). All\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species showed high susceptibility to amphotericin B and echinocandins (99.0% and 95.9%, respectively). Overall, there was a notable shift toward NACs, especially\n                      <jats:italic toggle=\"yes\">C. parapsilosis<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">C. tropicalis<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">C. guilliermondii<\/jats:italic>\n                      , accompanied by declining susceptibility to azoles (particularly in\n                      <jats:italic toggle=\"yes\">C. tropicalis<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">C. guilliermondii<\/jats:italic>\n                      ), which underscores the urgent need for enhanced antifungal stewardship and continuous resistance monitoring.\n                    <\/jats:p>\n                  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