Epidemiological Characteristics, Species Distribution, and Antifungal Resistance Profiles of Candidemia Cases

Local species distribution and antifungal susceptibility are important for empirical candidemia management. We retrospectively evaluated patients with Candida-positive blood cultures from August 2019 to May 2024. Episodes were defined using a 30-day window; species distribution and susceptibility were analysed at the episode-species level and outcomes at the patient level. Among 566 patients, 605 episodes and 637 episode-species isolates were identified. Non-albicans Candida accounted for 59.7%; C. albicans (40.3%) and C. parapsilosis (34.2%) predominated. Of 217 C. parapsilosis isolates tested, 66 (30.4%) were fluconazole-susceptible, 58 (26.7%) were susceptible dose-dependent, and 93 (42.9%) were resistant. Recurrent candidemia occurred in 37 patients and documented microbiological persistence in 128 (22.6%); persistence was more frequent when the index culture included C. parapsilosis (27.6% vs. 20.1%; OR 1.52, 95% CI 1.01-2.28). Among 32 patients with a shared species in the initial and first recurrent episodes, newly detected resistance occurred in three, all involving fluconazole-resistant C. parapsilosis. Thirty-day all-cause mortality was 57.4%; older age, ICU care, mechanical ventilation, and solid malignancy were independently associated with higher mortality. These findings suggest that empirical reliance on fluconazole may be inappropriate in settings with similar resistance patterns and support species-level identification, repeat blood cultures, and episode-specific susceptibility testing.