| Summary: | <b>Background</b>: <i>Candida parapsilosis</i> is the most common non-<i>albicans</i> candida species that causes invasive candidiasis, but little is known about its impacts on the outcomes of pediatric patients. We aimed to characterize the clinical characteristics, risk factors and outcomes of <i>C. parapsilosis</i> bloodstream infections (BSIs) in children. <b>Methods</b>: All pediatric patients with <i>Candida parapsilosis</i> BSIs between 2005 and 2020 from a medical center in Taiwan were enrolled and analyzed. The antifungal susceptibility, clinical manifestations, management and outcomes were investigated. Cases of <i>Candida parapsilosis</i> BSIs were compared between patients with <i>C. albicans</i> BSIs and other Candida spp. BSIs. <b>Results</b>: During the study period, 95 episodes (26.0% of total cases) of <i>Candida parapsilosis</i> BSIs were identified and analyzed. No significant difference was found between pediatric patients with <i>C. parapsilosis</i> BSIs and those with <i>C. albicans</i> BSIs in terms of patients’ demographics, most chronic comorbidities or risk factors. Pediatric patients with <i>C. parapsilosis</i> BSIs were significantly more likely to have previous azole exposure and be on total parenteral nutrition than those with <i>C. albicans</i> BSIs (17.9 vs. 7.6% and 76.8 vs. 63.7%, <i>p</i> = 0.015 and 0.029, respectively). The duration of <i>C. parapsilosis</i> candidemia was relatively longer, and therefore patients often required a longer duration of antifungal treatment when compared with those of <i>C. albicans</i> candidemia, although the candidemia-attributable mortality rates were comparable. Of the <i>C. parapsilosis</i> isolates, 93.7% were susceptible to all antifungal agents, and delayed appropriate antifungal treatment was an independent factor in treatment failure. <b>Conclusions</b>: Pediatric patients with <i>C. parapsilosis</i> BSIs were more likely to have previous azole exposure and be on total parenteral nutrition, and the clinical significances included a longer duration of candidemia and patients often required a longer duration of antifungal treatment.
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