Abstract
BACKGROUND: Fungal bloodstream infections (BSIs), particularly candidemia, are recognized as major contributors to hospital-acquired infections and mortality. Early species and antifungal drug resistance pattern identification are crucial for timely intervention and improved outcomes. Consequently, this study aimed to examine the distribution of Candida species isolated from blood cultures and assess their antifungal susceptibility profiles. METHODS: This retrospective observational study was conducted between January and December 2024. Candida species were identified via Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI TOF-MS), and antifungal susceptibility testing was performed using the Sensititre YeastOne method. RESULTS: Candidemia was detected in 118 (0.73%) of total blood culture samples (N = 16,040). Candida tropicalis was the most frequently isolated species (38, 32.20%), followed by Candida albicans (17, 14.41%) and Candida parapsilosis (16, 13.56%). Additionally, C. tropicalis exhibited the highest resistance to azoles, particularly posaconazole (30, 78.95%). In C. albicans, the highest resistance was observed against posaconazole (3, 17.65%) and less with other azoles. Similarly, C. parapsilosis demonstrated greater resistance to fluconazole (4, 25%). Nakaseomyces glabrata displayed high resistance to voriconazole (11, 84.62%) and posaconazole (8, 61.54%). Furthermore, Candida auris isolatesexhibited greaterresistance to fluconazole (7, 87.5%) and caspofungin (4, 50%). CONCLUSIONS: The increasing prevalence of non-albicans Candida (NAC) species and the rising resistance to commonly used antifungals, particularly azoles, underscore the importance of timely diagnosis, species-level identification, antifungal drug resistance testing, and targeted antifungal therapy for candidemia. Higher antifungal drug resistance to posaconazole and fluconazole across several Candida isolates highlights the importance of routine antifungal drug resistance testing for Candida isolates in BSIs. Echinocandins are generally effective against most Candida species; however, they should be used cautiously in patients with C. auris BSI, as C. auris isolates may exhibit multidrug resistance, including resistance to echinocandins.