Burden of non-invasive fungal infection and antifungal therapy in pediatric primary care setting: FUNGICARE Project

Background fungal infections are common worldwide and a frequent reason for pediatric primary care visits, mainly affecting the skin, hair, and nails, with a consistently high prevalence in outpatient settings. This study aimed to assess the burden of fungal infections in pediatric primary care in Italy and characterize the patterns of antifungal therapy use. Methods this population database analysis used data from Pedianet, a comprehensive database of 193 family pediatricians in Italy. The annual incidence rate (IR) of fungal infections was evaluated in children aged < 14 years from January 2010 to December 2024. Subjects were followed up from 2010 or their enrollment date until the end of assistance or the end of the study period. All antifungal treatments occurring within an episode were included. Results a total of 23,463 episodes of fungal infection were identified, including 23,034 episodes of skin and mucocutaneous mycoses and 429 episodes of onychomycosis. The most frequent diagnoses were Candida -associated diaper dermatitis (52.1%) and mucocutaneous candidiasis (27.4%). Between 2010 and 2019, the incidence of fungal infections remained stable at 11–14 cases per 1,000 person-years. A marked decline across all age groups was observed in 2020, reflecting the impact of the SARS-CoV-19 pandemic. Regarding treatment, 144/429 (33.6%) of onychomycosis episodes received an antifungal prescription, mainly tioconazole, while 8347/23034 (36.3%) of skin and mucocutaneous mycoses were treated, predominantly with clotrimazole. Conclusion this population-based cohort study updates the epidemiology of non-invasive fungal infections in pediatric outpatients and underscores the need for greater awareness, improved diagnosis, prevention, and antifungal stewardship in primary care.