Nosocomial bloodstream candidaemia is a life‐threatening fungal infection with high morbidity and mortality, especially among paediatric patients undergoing intensive immunosuppressive therapy. Limited data on the epidemiology of candidaemia and susceptibility profiles are available for Iran. To characterise candidaemia epidemiology, comorbidity risk factors, species distribution, and antifungal susceptibility profiles among paediatric patients in Iran. This observational cross‐sectional study enrolled 26 189 patients <18 years old at three reference paediatric hospitals in Mazandaran and Tehran over 2 years. Blood samples from patients with suspected fungal bloodstream infection were analysed using the BACTEC culture system. Fungal isolates were identified using matrix‐assisted laser desorption ionisation time‐of‐flight mass spectrometry (MALDI‐TOF) and DNA sequencing. Antifungal susceptibility testing was performed using the Clinical and Laboratory Standards Institute broth microdilution guideline. We observed 109 episodes of nosocomial candidaemia in paediatric patients with or without immunosuppressive therapy. The most common healthcare‐associated factor was central vascular catheter use (97%). The all‐cause mortality rate was 40%, of which 48% was attributable to candidaemia. While Candida albicans was the most frequent causative agent (49%), emerging and uncommon Candida species were also isolated. Candidaemia mortality by non‐albicans Candida species was significantly higher than that by C. albicans (P < .05). All fluconazole‐resistant species were non‐albicans Candida species. Uncommon Candida species with reduced susceptibility to antifungals are emerging as major agents of nosocomial candidaemia in high‐risk paediatric patients in Iran. Appropriate source control, antifungal regimens and improved antifungal stewardship are warranted for managing and decreasing the burden of nosocomial candidaemia.

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儿童、婴儿和新生儿院内念珠菌血症的流行病学特征：伊朗的一项多中心研究

院内血流念珠菌血症是一种危及生命的真菌感染，发病率和死亡率都很高，尤其是在接受强化免疫抑制治疗的儿科患者中。伊朗可获得的关于念珠菌血症和易感性特征的流行病学数据有限。表征伊朗儿科患者的念珠菌血症流行病学、合并症风险因素、物种分布和抗真菌药物敏感性。这项观察性横断面研究在马赞达兰和德黑兰的三个参考儿科医院招募了 26189 名 18 岁以下的患者，为期 2 年。使用 BACTEC 培养系统分析疑似真菌血流感染患者的血液样本。使用基质辅助激光解吸电离飞行时间质谱 (MALDI-TOF) 和 DNA 测序鉴定真菌分离株。使用临床和实验室标准研究所肉汤微量稀释指南进行抗真菌药敏试验。我们在接受或未接受免疫抑制治疗的儿科患者中观察了 109 次院内念珠菌血症。最常见的医疗保健相关因素是中心血管导管的使用 (97%)。全因死亡率为 40%，其中 48% 可归因于念珠菌血症。虽然白色念珠菌是最常见的病原体 (49%)，但也分离出新出现的和不常见的念珠菌。非白色念珠菌的念珠菌血症死亡率显着高于白色念珠菌（P < .05）。所有氟康唑耐药菌种均为非白色念珠菌属。对抗真菌药敏感性降低的罕见念珠菌正在成为伊朗高危儿科患者院内念珠菌血症的主要病原体。适当的源控制、抗真菌方案和改进的抗真菌管理对于管理和减少院内念珠菌血症的负担是必要的。