Species Distribution, Drug Resistance, and Risk Determinants of Candida UTIs: A Five-Year Retrospective Study in Beijing.

OBJECTIVE

The Candida genus has become an important pathogen of urinary tract infections (UTIs). Systemic infections caused by Candida could result in high mortality and significant medical costs, presenting an increasingly severe clinical challenge. This five-year retrospective study was designed to investigate the species distribution, antifungal resistance patterns and clinical risk factors associated with Candida urinary tract infections, it is critical to guide the rational selection of antifungal agents and optimize clinical management strategies.

METHODS

This retrospective study analyzed 229 cases of Candida UTIs diagnosed at the Third Medical Center of the Chinese PLA General Hospital between 2020 and 2024. Species distribution and antifungal susceptibility were evaluated using chi-square tests, while multivariate logistic regression was employed to identify independent risk factors.

RESULTS

1. A total of 230 Candida strains were isolated from 229 patients (138 males and 91 females). The detection rate of C. albicans decreased from 47.06% in 2020 to 39.22% in 2024, with a corresponding rise in non-albicans species.2. Among the 199 strains tested for antifungal susceptibility, all isolates remained fully susceptible to amphotericin B and 5-fluorocytosine (0.00% resistance). In contrast, resistance to azole antifungals was notably higher. C. tropicalis exhibited significantly greater resistance to triazole agents compared to C. albicans (P<0.05), while C. glabrata demonstrated a high resistance rate to itraconazole (44.00%), indicating a growing resistance concern. 3. Univariate analysis showed that hospital stays ≥14 days, urinary catheterization ≥7 days, and broad-spectrum antibiotic use were significantly associated with Candida UTIs (P<0.05). Multivariate logistic regression identified prolonged hospitalization and catheterization as independent risk factors (P<0.05).

CONCLUSION

The increasing prevalence of non-Candida albicans species and rising azole resistance-particularly among Candida tropicalis-underscore the importance of routine species identification and antifungal susceptibility testing. Early urine culture screening and individualized antifungal selection are crucial, especially for patients with prolonged hospital stays or indwelling catheters, promoting the transition from empirical medication use to individualized treatment in clinical practice.