Species Distribution and Antifungal Susceptibility of Candida Isolates From Candidemia: Findings at a Tertiary Academic Medical Center From 2018 to 2025.

Background and objective Candidemia remains a major cause of bloodstream infections, associated with substantial morbidity and mortality. Ongoing surveillance is needed because the distribution of Candida species and patterns of antifungal resistance continue to evolve. This study aimed to characterize the epidemiology and antifungal susceptibility profiles of Candida species isolated from blood cultures at a tertiary academic medical center from 2018 to 2025. Methods We conducted a retrospective laboratory-based analysis of non-duplicate Candida isolates recovered from positive blood cultures between January 2018 and December 2025. Species identification was performed using MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight) mass spectrometry. Antifungal susceptibility testing was conducted using Sensititre™ YeastOne™ (Thermo Fisher Scientific, Cleveland, OH) panels and interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results A total of 717 Candida bloodstream isolates were identified. The most common species were Candida albicans (C. albicans) (242/717; 33.8%), Nakaseomyces glabratus (N. glabratus) (230/717; 32.1%), C. parapsilosis (122/717; 17.0%), C. tropicalis (56/717; 7.8%), C. dubliniensis (30/717; 4.2%), Pichia kudriavzevii (P. kudriavzevii) (15/717; 2.1%), and Clavispora lusitaniae (C. lusitaniae) (13/717; 1.8%). Overall, non-albicans species accounted for 475 of 717 cases (66.2%). Antifungal susceptibility remained largely preserved during most of the study period. C. albicans showed low resistance to fluconazole (5/242; 2.1%) and voriconazole (1/242; 0.4%), with no echinocandin resistance detected. Among N. glabratus, 23 (10%) of 230 isolates were fluconazole-resistant, and echinocandin resistance was uncommon. C. parapsilosis and C. tropicalis demonstrated moderate fluconazole resistance. Resistance increased in 2025, particularly to fluconazole (13/79; 16.5%) and caspofungin (9/79; 11.4%). Conclusions Non-albicans species caused most candidemia cases, with N. glabratus occurring nearly as often as C. albicans. Emerging resistance underscores the importance of species-level identification, susceptibility testing, and ongoing surveillance to guide therapy and antifungal stewardship.