Species Distribution, Antifungal Resistance, and Risk Factors of Candida Bloodstream Infections in a Tertiary Care...

Understanding trends in Candida infections and their resistance patterns is essential for improving patient outcomes and guiding effective treatment strategies. This study aimed to investigate the distribution of Candida species, their resistance to antifungal medications, and the risk factors associated with infection in a tertiary care hospital over a two-years period.

We performed a cross-sectional study at Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences. Blood samples from patients suspected of having bloodstream infections were examined using the BACTEC system, and Candida species were identified using PCR-RFLP. Antifungal susceptibility testing was performed following CLSI guidelines.

Ninety-five cases were confirmed as candidemia. The most common species identified was Candida albicans (n=52, 54.7%), followed by Candida parapsilosis complex (n=18, 18.9%) and Nakaseomyces glabratus complex (n=12, 12.6%). Antifungal susceptibility testing indicated that, although C. albicans remained mainly susceptible to treatment, non-albicans Candida species showed reduced susceptibility, especially to azoles. The overall mortality rate was 57.8% (n=55), with the highest number of deaths occurring in intensive care units (41.8%, n=23/55). In the multivariable logistic regression analysis, increasing age, intensive care unit admission, and higher white blood cell count were independently associated with mortality.

Non-albicans Candida species with reduced azole susceptibility were common. Mortality was associated with intensive care unit admission, older age, and elevated white blood cell counts, while rapid antifungal therapy remained critical for improving survival.