Multidrug-Resistant Candida in Bloodstream Infections: A Growing Concern in Indian Healthcare

Bloodstream Candida infection, or candidemia, is a serious fungal infection caused by Candida species, often occurring in hospitalized or immunocompromised patients. It can lead to severe complications, including sepsis and multi-organ failure. The emergence of antifungal resistance, particularly in species like Candida auris and Candida glabrata, poses a significant challenge to treatment.

This was a hospital-based retrospective study conducted over a five-year period, from January 2020 to December 2024. All bloodstream infection clinical sample details were collected from the microbiology laboratory with Candida infection. A total of 1058 isolates of Candida species were included in the study. The study samples were the clinically relevant Candida isolates for which antifungal susceptibility testing was done at a tertiary care hospital in North India. The data were entered into a database, and an antibiogram for Candida species was generated.  Results: Candida tropicalis was the most prevalent, with 340 isolates, which make up 32.13% of the total isolates of Candida. Candida parapsilosis was the next most common, with 145 isolates, comprising 13.7% of the total isolates. Candida auris accounted for 100 isolates, representing 9.45% of the total isolates. Candida albicans, the fourth most common Candida genus, was 96 isolates (9.07%), making it less common in comparison to Candida non-albicans. Isolates from paediatric patients dominate the list, with significantly higher samples compared to the others, followed by adult patients from medicine departments with 218 samples, showing its importance in overall sample contributions. Among antifungals, caspofungin had the highest sensitivity across most species, e.g., Candida albicans at 94.7%, Candida parapsilosis at 98.6%, and Candida tropicalis at 97.5%. Caspofungin was found to be 96% sensitive to Candida auris. Fluconazole displays variable effectiveness as low susceptibility was found in Candida auris (8.9%) and Candida glabrata (35.1%). Voriconazole maintains relatively high susceptibility, with better performance compared to fluconazole in most species, e.g., Candida albicans (84%) and Candida glabrata (78.9%).

Candida tropicalis emerged as the most prevalent species, followed by Candida parapsilosis, Candida auris, and Candida albicans, with non-albicans species being more common overall. Candida resistance is a growing clinical challenge that requires urgent attention. At one time, Candida albicans was the most common organism; however, Candida auris has now emerged as the most common resistant pathogen in hospitals across India, with its resistance continuing to increase.