Blood Stream Infections due to Candida Species: Prevalence, Risk Factors, Mortality, and Susceptibility Profile Over 3-Year Period: A Single Center Study.

BACKGROUND: Candida is one of the most common causes of bloodstream infections in critically ill and immunocompromised patients. Understanding the distribution and antifungal resistance patterns of Candida species and the associated mortality rates is critical for tailoring therapeutic measures. OBJECTIVES: The aim of this study is to analyze the epidemiology, antifungal resistance trends, and risk factors influencing mortality associated with candidemia in a tertiary healthcare center of Saudi Arabia. PATIENT AND METHODS: The study included all cases of bloodstream infections caused by Candida species from December 2021 to January 2023. The antifungal susceptibility and identification of species were done via standard protocols. Univariate and multivariate statistical analyses were conducted to determine the predictors of 14-day mortality (death within 14 days of the first positive blood culture) and overall (in-hospital) mortality (death during the index hospitalization). RESULTS: Fifty patients were included in the study with a median age of 71 years, with 58% being females. C. albicans accounted for 21.3% of candidemia cases, with a declining trend over time. Candidozyma auris (formerly Candida auris) was the most frequently identified non-albicans Candida species (25%). Fluctuating trends in antifungal susceptibility of non-albicans Candida were observed, with increasing resistance to azoles, while increasing susceptibility to micafungin. The 14-day mortality and overall (in-hospital) mortality rates were 23.4% and 55.3%, respectively. Multivariate analysis revealed older age, cardiac and respiratory disorders, ICU as site of diagnosis, treatment duration of > 48 h, and Candida colonization to be independent predictors of overall (in-hospital) mortality (p < 0.05). CONCLUSION: The continuous rise of antifungal resistance and spread of non-albicans Candida species highlight the need for implementing rigorous control measures in healthcare facilities. Improving candidemia outcomes requires prompt identification of high-risk patients and targeted therapies.