Association of virulence factors with antifungal resistance and clinical outcomes in Candida species isolated from bloodstream infections.

Candidemia represent a significant cause of morbidity and mortality in hospitalized patients. Mortality depends on the virulence and resistance profile of the organism. This study aimed to evaluate virulence factors in Candida species isolated from bloodstream infections and correlate them with antifungal resistance patterns and clinical outcomes. 100 Candida isolates from blood cultures were collected over one year. Virulence factors including hemolysin, phospholipase, and proteinase activities, along with biofilm formation, were assessed. Susceptibility to antifungal was assessed using the VITEK®2 system. Clinical data and outcomes were analysed in relation to virulence factors and resistance patterns. Non-albicans Candida species (NAC) predominated (90%) over C. albicans (10%). C. parapsilosis (32%) and C. tropicalis (30%) were the most common NAC species. Overall, hemolysin activity was detected in 79% of isolates, phospholipase in 51%, proteinase in 43%, and biofilm formation in 87%. C. auris and C. duobushaemulonii demonstrated the strongest virulence factor expression. Fluconazole resistance was observed in 22% of isolates, with C. auris showing 100% resistance. Isolates with stronger enzymatic activities and biofilm formation showed significantly higher antifungal resistance (P < 0.0001). The crude mortality rate was 27%, with significantly higher mortality in patients infected with resistant isolates and those expressing strong virulence factors (P < 0.05). NAC species have emerged as predominant causative agents of candidemia, demonstrating higher virulence factor expression and antifungal resistance compared to C. albicans. The correlation between virulence factors, antifungal resistance, and mortality highlights the importance of species-level identification and antifungal susceptibility testing for optimal management of candidemia.