Clinical characteristics and antifungal susceptibility of uncommon Candida species causing candidemia in Southern Taiwan.

BACKGROUND: Candidemia caused by uncommon Candida species (species other than Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, and Candida krusei) is reported to be an emerging issue. Our study aimed to examine clinical features and risk factors associated with mortality of patients who had uncommon Candida species infection. METHODS: Patients infected with uncommon Candida spp. candidemia were investigated at Kaohsiung Chang Gung Memorial Hospital, Taiwan from 2014 to 2025. Identification of Candida spp. was performed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or molecular method. In vitro susceptibility test was conducted using the broth microdilution method. The clinical manifestation and risk factors associated with 30-day all-cause mortality were analyzed. We also summarized antifungal susceptibility profiles of each isolate to eleven antifungal agents, including novel agents isavuconazole and manogepix. RESULTS: Among the 75 patients, Meyerozyma guilliermondii (n = 23) was the most frequently identified species. Older age (AOR, 1.06; 95% CI, 1.02-1.11) and ICU admission (AOR, 4.52; 95% CI, 1.13-18.13) were associated with increased 30-day all-cause mortality, whereas abdominal surgery was associated with decreased mortality (AOR, 0.16; 95% CI, 0.03-0.84). M. guilliermondii exhibited elevated fluconazole MICs, while species-specific outcomes varied substantially. No significant association was observed between 30-day all-cause mortality and empirical antifungal therapy. CONCLUSIONS: Uncommon Candida species exhibited diverse antifungal susceptibility patterns. Host-related factors were associated with 30-day all-cause mortality, whereas no significant association was observed between early antifungal treatment metrics and mortality in this cohort.