A Retrospective Study of Invasive Candidiasis in a Tertiary Teaching Hospital

Introduction Invasive candidiasis is a leading cause of fungal infections in hospitalized and critically ill patients, with high morbidity and mortality. There are numerous factors which may predispose to its development. In recent years, there has been a change in the etiological spectrum, and emerging resistance to antifungal drugs seen in some patients, further complicating management. Aims and objectives The aim of this study was to analyze the epidemiological and microbiological profile of invasive candidiasis in a tertiary teaching hospital, with a focus on species distribution, antifungal resistance patterns, clinical risk factors, and patient outcomes. Materials and methods This retrospective study included all consecutive adult inpatients with invasive candidiasis admitted to Bharati Hospital & Research Centre, Pune, India, from April 2019 to March 2022. This cohort represents all eligible cases (n=86) identified during the study period, and therefore, the sample size was determined by case availability rather than a prior statistical calculation. Data were collected to evaluate species distribution and evolving epidemiology, identify associated risk factors, analyse antifungal susceptibility patterns, and determine mortality outcomes. Results Candida albicans (CA) was isolated in 19 (22.09%) out of 86 cases, while non-albicans Candida (NAC) in 67 (77.91%) of patients. The most common species isolated among NAC was Candida parapsilosis in 28 (32.56%) cases, followed by Candida tropicalis in 19 (22.09%) cases and Candida auris in 12 (13.95%) cases. Out of 86 patients with invasive candidiasis, we found antibiotic use in 81 (94.2%) cases, intravascular catheters (central venous line/hemodialysis catheter) in 65 (75.6%) cases, Foley catheter in 49 (57%) cases, diabetes mellitus (DM) in 41 (47.7%) cases, chronic kidney disease (CKD)/acute kidney injury (AKI) in 41 (47.7%) of patients, and surgery in 28 (32.6%) patients. Other associated factors found were steroid and immunosuppressive use, total parenteral nutrition, cancer chemotherapy, human immunodeficiency virus (HIV) positive status and prosthetic devices. Mortality was seen in 24 (27.9%) patients. Patients with two or more associated illnesses had mortality 2.36 times more than those with less than two illnesses (p value = 0.016). Conclusion Invasive candidiasis in hospitalized patients remains a significant challenge, driven by rising non-albicans species and increasing antifungal resistance. Early recognition in high-risk patients, antimicrobial stewardship, and meticulous catheter care are essential to prevent morbidity and mortality. Improved availability of more sensitive tests to detect invasive candidiasis infections is the need of the day so that antifungals can be started at the correct time.