Mycological and Clinical Profile of Candidemia in Intensive Care Unit Patients

Abstract

Objective: To analyze the clinical features, risk factors, species distribution, and antifungal susceptibility of Candida bloodstream infections in intensive care unit patients in the context of rising invasive candidiasis and the shift from Candida albicans to non-albicans Candida species with higher antifungal resistance, emphasizing the need for monitoring local epidemiology to guide appropriate antifungal therapy.Material and Methods: Blood cultures from patients with a strong clinical suspicion of sepsis were included. Blood culture isolates were identified, and antifungal susceptibility testing of Candida isolates was performed. Demographic characteristics, comorbid conditions, clinical parameters, and patient outcomes, including duration of hospital stay and 30-day mortality, were recorded and analyzed.Results: Out of 4,112 blood cultures, 1,183 (28.8%) were culture positive. The mean time to positivity was 16.4 ± 1.8 hours. Candida spp. were isolated from 27 (2.3%) patients, with NAC species predominating. Diabetes mellitus, corticosteroid use, and indwelling medical devices were significantly associated with Candida BSI. Hospital and ICU stay duration were significantly higher in patients with Candida BSI compared to bacterial BSI. Fluconazole resistance was observed in 18.5% of isolates. The C. parapsilosis complex demonstrated high minimum inhibitory concentrations to echinocandins.Conclusion: Candida is an important cause of bloodstream infections in ICU patients. The emergence of non-albicans Candida with reduced fluconazole susceptibility and elevated echinocandin MICs in C. parapsilosis complex highlights the need for continuous surveillance and judicious antifungal use.