Candidemia in ICU and Non-ICU Settings: Species Distribution and Antifungal Resistance Patterns from a Tertiary Care Center in India with Reference to ICMR AMR 2024.

BACKGROUND

Candidemia is a major cause of invasive fungal bloodstream infections associated with significant morbidity and mortality. An increase in bloodstream infections caused by nonalbicans Candida species is concerning because it has different epidemiological characteristics and antifungal susceptibility compared to C. albicans. Resistance to antifungal agents, particularly azoles, complicates treatment.

MATERIALS AND

METHODS

This retrospective hospital-based observational study was carried out in the Department of Microbiology, Saveetha Medical College, Chennai, from January 2025 to December 2025. Blood samples were collected and loaded into the BACT/ALERT automated system for microbial detection. Identification and antifungal susceptibility testing (AFST) were performed using the VITEK 2 automated system. CLSI M60 guidelines were used for interpreting the results.

RESULTS

Candida species were isolated in 68/1207 (5.6%) positive blood cultures; 38/68 (55.9%) from ICU and 30/68 (44.1%) from non-ICU settings. Males (27/38, 71.1%) predominated in ICU, whereas females (18/30, 60%) predominated in non-ICU. The most commonly isolated species in the non-ICU setting was C. auris (11/30, 36.7%), whereas in the ICU setting it was C. tropicalis (13/38, 34.2%). C. albicans and C. glabrata showed 100% susceptibility, whereas C. auris demonstrated high resistance to azoles with variable resistance to echinocandins. Diabetes mellitus was the most common risk factor in both settings. Mortality was higher in ICU patients (9/38, 23.7%) than non-ICU patients (5/30, 16.7%); however, this difference was not statistically significant (p = 0.47).

CONCLUSION

Candidemia remains a significant source of bloodstream infections with a notable trend toward nonalbicans species and emerging antifungal resistance. Continuous surveillance and appropriate infection control practices are essential.