| Summary: | <i>Candida</i> spp. can cause bloodstream infection and is associated with significant mortality. The proportion of fluconazole-resistant <i>Candida</i> non<i>-albicans</i> has increased over the years, and empirical fluconazole maybe inappropriate. In this retrospective study, we analyzed clinical characteristics, antifungal resistance patterns, and mortality in children with candidemia treated at a tertiary medical center in Jerusalem between 2009 and 2022. A total of 122 children developed 127 candidemia episodes with 132 <i>Candida</i> isolates. Half the episodes occurred in immunocompromised children. Septic shock was present in 27 (21.3%). <i>Candida</i> non-<i>albicans</i> was responsible for 71/132 (56.5%) episodes; 16/132 (12.1%) of isolates were fluconazole-resistant. The rate of <i>Candida</i> non-<i>albicans</i> was significantly higher in fluconazole-resistant episodes (90 vs. 50.5%, <i>p</i> = 0.02). Prolonged severe neutropenia and previous fluconazole exposure were more frequent in fluconazole-resistant episodes. Thirty-day mortality was 25 (19.7%). Greater mortality, as shown by multivariate analysis, was associated with candidemia contracted in the pediatric intensive care unit (PICU), previous use of azoles or carbapenems, and in the presence of shock. In conclusion, mortality rates in our study were higher than those previously reported. In suspected infection associated with factors which we found to increase the probability of mortality—PICU admission, shock, and earlier azole or carbapenems exposure—empirical antifungals should be considered.
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