Species Distribution and Antifungal Susceptibility Patterns of Candida Isolates: A Cross-Sectional Study From a Tertiary Care Hospital in South India.

Background The increasing prevalence of Candida infections and emerging antifungal resistance presents a significant challenge in tertiary healthcare settings. The epidemiological landscape of candidiasis is evolving, with non-albicans Candida species gaining prominence. This cross-sectional study aimed to investigate the distribution patterns of Candida species isolated from various clinical specimens at Srinivasan Medical College and Hospital, Samayapuram, India with particular emphasis on emerging non-albicans species that demonstrate varying virulence and antifungal susceptibility profiles. Methodology The study employed a hospital-based cross-sectional design conducted over six months from October 2023 to March 2024. A sample size of 97 clinical specimens was processed using standardized microbiological procedures, including potassium hydroxide (KOH) mount, Gram staining, and culture on Sabouraud's dextrose agar. Species identification utilized the Germ Tube Test, CHROMagar, and corn-meal agar techniques. Antifungal susceptibility testing was performed via disk diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines for fluconazole, voriconazole, itraconazole, and amphotericin B. Statistical analysis employed Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY), utilizing descriptive statistics, chi-square tests, and multivariate logistic regression. Results The study population demonstrated a mean age of 47.9 years, comprising 52 female and 45 male patients. Among clinical specimens, urinary samples constituted 51 specimens (52.6%), followed by high vaginal swabs with 23 specimens (23.7%), and sputum with 15 specimens (15.5%). Microbiological analysis revealed 45 isolates of Candida albicans (46.4%), while non-albicans species included 25 isolates of C. tropicalis (25.8%), 20 of C. krusei (20.6%), and 7 of C. glabrata (7.2%). Diabetes mellitus emerged as the predominant risk factor, affecting 38 patients (39.2%). Antifungal susceptibility testing demonstrated complete sensitivity to amphotericin B and voriconazole across all isolates, while 32 isolates showed resistance to itraconazole (33.0%). Fluconazole resistance patterns revealed 19 isolates with acquired resistance (19.6%) and 20 isolates with intrinsic resistance (20.6%). Conclusion The study reveals a significant prevalence of non-albicans Candida species and concerning levels of antifungal resistance, particularly to azoles. These findings emphasize the critical importance of species identification and antifungal susceptibility testing in guiding therapeutic decisions for Candida infections.