Management of Pediatric Candida Central Nervous System Infections: A Retrospective Analysis of a Challenging Case Series

Purpose Central nervous system (CNS) infections caused by Candida species are serious clinical conditions associated with high morbidity and mortality, especially in children with neurosurgical devices. The aim of this study is to evaluate the clinical characteristics, changing microbiological profile, and treatment outcomes of pediatric Candida meningitis/ventriculitis cases followed in our center. Methods Twenty-five pediatric patients followed in the Pediatric Infectious Diseases clinic with Candida growth in CSF or shunt culture were analyzed retrospectively. Demographic data, risk factors, CSF findings, isolated species, and treatment approaches were analyzed. Results The mean age of the patients was 29.4 ± 34.6 months, and 84% (n = 21) had a history of ventriculoperitoneal (VP) shunt. Prior broad-spectrum antibiotic use and history of neurosurgical intervention were detected in all patients (100%). CSF analysis revealed markedly elevated protein levels (mean 767 mg/dL). Although Candida spp. (76%) was the leading isolate, Candida auris , considered a global threat, was detected in one case. The mean length of hospital stay was 83 days, and the mortality rate was 12%. Treatment failure was observed in cases where the shunt was not removed, whereas cure was achieved in patients who underwent shunt revision and systemic antifungal therapy. Conclusion The presence of a VP shunt and intensive antibiotic use are the primary risk factors for pediatric fungal CNS infections. The emergence of resistant species such as C. auris in childhood complicates treatment strategies. Immediate removal of the shunt and aggressive antifungal therapy targeted at the agent are essential for successful management.