Current understanding of epidemiology and diagnosis method of candidemia in Indonesia: A review

Candidemia is an important but under-characterised bloodstream infection in Indonesia, occurring in a context of expanding populations at risk, emerging antifungal resistance and gaps in prevention and control. An estimated 7.7 million Indonesians (2.89% of the population) are affected by serious fungal diseases annually; this figure is not an estimate of candidemia incidence. The epidemiology of candidemia is complex, with various Candida species contributing to the disease burden. Early and accurate diagnosis is crucial for appropriate antifungal therapy. Conventional blood culture remains the reference method for diagnosing candidemia; however, the availability and routine use of CHROMagar Candida, VITEK and advanced diagnostic platforms across Indonesia have not been systematically characterised. Potential diagnostic approaches include serological assays, mass spectrometry, and molecular methods such as real-time PCR and sequencing. Frequently reported species in Indonesian studies include C. tropicalis, C. albicans and C. parapsilosis, although study populations and case definitions vary. Indonesian evidence for C. auris is limited to one molecularly confirmed archived isolate and other isolate reports lacking sufficient specimen, confirmatory or patient-level data to determine the number of affected patients or the national clinical burden. Where available, molecular methods may aid identification when phenotypic methods are inconclusive; results should be interpreted alongside culture findings and clinical data.