Trends in candidemia and antifungal resistance: a nine-year single-center study in Turkey.

BACKGROUND

Candidemia is a major global health concern with rising incidence and mortality. Regional surveillance is essential, as species distribution and antifungal resistance vary significantly.

METHODS

We analyzed 541 Candida isolates from blood cultures at Cerrahpaşa Medical Faculty Hospital (2015–2023). Identification was performed using phenotypic methods, API 20 C AUX, BD Phoenix YEAST ID, and MALDI-TOF MS. Antifungal susceptibility was tested by gradient test (E-test) on RPMI agar, interpreted according to EUCAST guidelines for azoles, echinocandins, and amphotericin B.

RESULTS

The most frequent isolates were C. albicans (n = 214, 39%; susceptibility tested in 150), C. parapsilosis (n = 164, 29%), C. glabrata (n = 47, 7%), C. tropicalis (n = 42, 7%), and C. krusei (n = 10, 2%). Other species accounted for 16% (n = 64), including cryptic species such as C. auris (n = 9) and C. haemulonii (n = 1). The total cases were 269 in the pre-COVID period and 272 in the COVID and post period, chi-square analysis indicated these differences were not statistically significant (χ²=7.43, df = 6, p = 0.283). Increased MIC values ​​against azoles were significantly detected in C. glabrata isolates, while C. parapsilosis complex generally exhibited a relatively high MIC distribution and a decreased susceptibility pattern. C. krusei demonstrated intrinsic resistance to fluconazole but remained susceptible to voriconazole.

CONCLUSIONS

Our findings demonstrate a shift, though not statistically significant, toward non-albicans Candida species with emerging azole resistance, including the detection of multidrug-resistant C. auris. These trends underscore the need for enhanced local surveillance, molecular diagnostics, and evidence-based antifungal stewardship to optimize patient outcomes. CLINICAL TRIAL NUMBER: Not applicable.