Clinical correlates for fluconazole resistance in Candida bloodstream infections

Candidemia poses a growing global health threat, with rising fluconazole resistance complicating clinical management. This study aimed to investigate the species distribution and fluconazole resistance profiles of Candida bloodstream infections and identify risk factors associated with fluconazole resistance.

A retrospective study was conducted at a tertiary care hospital in Guangzhou, China, from 2023 to 2025. Candida isolates from blood cultures were identified using MALDI-TOF MS, and antifungal susceptibility testing was performed using the VITEK 2 system. Patients were categorized into fluconazole-resistant and non-resistant groups based on species-specific MIC breakpoints.

A total of 94 Candida bloodstream infection cases were analyzed. The species distribution was: Candida albicans (26.60%), Candida glabrata (23.40%), Candida auris (20.21%), Candida tropicalis (15.96%), Candida parapsilosis (11.70%), and others (2.12%). Fluconazole resistance rates were highest in Candida auris (68.42%), followed by Candida tropicalis (46.67%) and Candida parapsilosis (9.09%). For Candida auris infections, indwelling medical devices (p = 0.017), antifungal use (p = 0.044), and antibacterial use (p = 0.004) were associated with fluconazole resistance. For Candida tropicalis infections, surgical history (p = 0.041) was the only factor associated with fluconazole resistance.

Candida auris and Candida tropicalis demonstrated alarmingly high fluconazole resistance rates, while Candida albicans and Candida glabrata remained susceptible. Indwelling medical devices, prior antimicrobial exposure and antibacterial exposure were identified as factors associated with fluconazole resistance, particularly in Candida auris infections. These findings indicate that enhanced infection control measures are warranted.