Epidemiology, Antifungal Susceptibility, and Risk Factors of Invasive Candidiasis in a Tertiary Hospital During a Four-Year Period

Candidainfections are a significant cause of morbidity and mortality in hospitalized patients. Acquired resistance to antifungal agents and strains with intrinsic resistance makes it hard to manage the infection. Objectives: We aimed to examine the risk factors of candidemia associated with patient mortality, the species causing candidemia, and their antifungal susceptibility. Methods: Patient data were collected from medical records retrospectively. MALDI-TOF MS was used to identify Candidaspecies. Antifungal susceptibility testing was conducted by the colorimetric broth microdilution method. Results: A total of 155 patients were included in the study. The incidences of candidemia were 0.92, 0.72, 0.99, 0.97, and 2.28 per 1,000 cases in 2016, 2017, 2018, 2019, and 2020, respectively. Candida albicansaccounted for 45% of all cases, followed by C. parapsilosiscomplex (28%), C. tropicalis(10%), and C. glabrata(8%). The 30-day crude mortality was 45%. There was no significant difference in mortality between C. albicansand non- albicansyeast species. The susceptibility rates for anidulafungin, micafungin, caspofungin, voriconazole, an C. albicans, 95, 95, 98, 72, and 67% in C. parapsilosiscomplex, and 100, 100, 100, 38, and 63% in C. tropicalis. The susceptibility rates for anidulafungin, micafungin, and caspofungin in C. glabratawere 100, 100, and 92%, respectively. All 12 C. glabratastrains were susceptible-dose- pendent against fluconazole and uninterpretable for voriconazole. Conclusions: Incidences of candidemia and susceptibility patterns of strains may vary over time and amongst the regions. Candida albicanswas the predominant strain, and echinocandins demonstrated the highest susceptibility rates against the most common species isolated in this study. Antifungal susceptibility tests are crucial in guiding patient treatment.