Abstract

Background: Candidemia carries case-fatality rates exceeding 30% in pediatric oncology cohorts from low- and middle-income countries. We describe a temporal cluster of culture-confirmed candidemia cases at King Hussein Cancer Center (KHCC), Amman, Jordan, coinciding with a novel environmental event and the multidisciplinary infection prevention and control (IPC) response undertaken. Methods: This retrospective cohort study describes seven pediatric inpatients with culture-confirmed candidemia identified between June 1 and September 30, 2025, at a 330-bed tertiary oncology center against a background rate of one confirmed case in the preceding six months. An additional five patients with clinically suspected invasive fungal infection (IFI) but negative blood cultures are described separately. Species identification was performed using the BioFire FilmArray Blood Culture Identification (BCID) panel (multiplex PCR); MALDI-TOF MS was additionally available; antifungal susceptibility was determined using the Sensititre system (Thermo Fisher Scientific, UK). Results: The seven confirmed cases comprised six males and one female (median age: 12 years; range: 1–17 years). Underlying diagnoses were predominantly leukemia (71%). All patients had a central venous catheter (CVC) in situ and recent broad-spectrum antibiotic exposure. Candida tropicalis was the predominant species (57%), with azole resistance identified in 42% of tested isolates. A plumbing infrastructure failure with an associated water leak was identified in late August 2025 during the cluster investigation; structural repair was completed in September 2025. The last confirmed case was recorded on 23 September 2025. All patients received guideline-concordant echinocandin- or amphotericin-based therapy. Candidemia-attributable mortality was 14% (1/7). Conclusions: A temporal cluster of seven culture-confirmed candidemia cases—representing a 7-fold increase above background incidence—was identified at a Jordanian pediatric oncology center. The cluster coincided with a documented environmental water leak. Individual single-room isolation, geographic ward sectioning, contact precautions, hand hygiene monitoring, expanded antifungal prophylaxis with real-time protocol adjustment, and environmental remediation were all implemented and documented with defined operational criteria. These data demonstrate that a structured, criteria-driven IPC bundle is operationally feasible at a resource-limited tertiary oncology center.

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