Bridging the gap between guidelines and practice: real-world evaluation of Candida management and outcomes in a Turkish tertiary care center.

BACKGROUND

Candida species are important causes of morbidity and mortality, with increasing antifungal resistance representing a major clinical challenge. Guideline adherence plays a critical role in optimizing outcomes.

METHODS

This retrospective study included adult patients hospitalized at a tertiary care center between 2022 and 2023 with Candida species isolated from blood, urine, tracheal aspirate, catheter tip, tissue, or oral swab samples. Demographic, clinical, and laboratory data were obtained from electronic records. Invasive candidiasis and colonization were defined according to the IDSA 2016 and ESCMID 2012 guidelines. The EQUAL Candida score was used to assess compliance in candidemia.

RESULTS

A total of 316 patients were included; the mean age was 64.4 ± 18.0 years, and 54.1% were female. C. albicans accounted for 83.2% of isolates identified at the time of growth and 35.0% of those identified retrospectively. Candidozyma auris was detected exclusively among retrospectively identified isolates and was more frequent in patients with prior antifungal exposure. The most common site of isolation was urine (47.1%), followed by respiratory tract (23.2%) and bloodstream (12.3%). Compliance with the IDSA and ESCMID guidelines for candiduria was 84.4% and 85.1%, respectively; however, 31.3% of patients who received antifungal therapy were deemed to have been treated unnecessarily. In candidemia, the mean EQUAL Candida score was 13.5 ± 4.8, and 30-day mortality was 46.8%.

CONCLUSION

Adherence to international guidelines in this real-world cohort was high, yet mortality remained substantial. Non-albicans Candida and Candidozyma auris were more frequent in patients with prior antifungal exposure, highlighting the need for improved antifungal stewardship in routine clinical practice. CLINICAL TRIAL NUMBER: Not applicable. (No individual or identifiable patient data are included in this manuscript.)