Evaluation of Species Distribution, Antifungal Susceptibility, and Mortality in Candidemia Cases

Year 2025, Volume: 10 Issue: 4, 121 - 128, 31.12.2025

Hale Ahsen Yardibi Demir , Furkan Arabacı , Çetin Kılınç

https://doi.org/10.58854/jicm.1835701

https://izlik.org/JA75XL76YH

Abstract

Objective: This study aimed to evaluate the distribution of Candida species, antifungal susceptibility profiles, and 30-day mortality rates in candidemia cases identified in our hospital over a one-year period.
Materials and Methods: A total of 98 candidemia cases with Candida species isolated from blood cultures between 01 April 2024 and 30 April 2025 were retrospectively analyzed. Species identification and antifungal susceptibility testing were performed using the Vitek 2 Compact automated system. Demographic characteristics, Candida species distribution, antifungal resistance rates, and 30-day mortality were assessed.
Results: Of the 98 candidemia cases, 59.1% were male and 40.9% were female, with a mean age of 73.95±11.40 years. The majority of cases (87.8%) originated from intensive care units. Among the isolates, C. albicans was the most frequently detected species (54.1%). Among non-albicans species, the most common were C. tropicalis (18.4%), C. parapsilosis (13.3%), C. glabrata (9.2%), followed by C. auris (2.0%), C. guilliermondii (2.0%), and C. dubliniensis (1.0%). Antifungal susceptibility testing revealed resistance rates of 1% for amphotericin B, 4.7% for fluconazole, and 3.5% for voriconazole. Resistance to echinocandins was detected in 4.2% of isolates. The 30-day mortality rate was 63.3% (62/98). There was no statistically significant difference in mortality among Candida species (p=0.25). The mean age of patients who died (76.4±10.46) was significantly higher than that of survivors (69.66±11.81) (p=0.006). Although mortality was higher in males compared to females, the difference was not statistically significant (p=0.23).
Conclusion: Comprehensive evaluation of species distribution, antifungal resistance patterns, and mortality outcomes is essential for improving patient management and guiding effective treatment strategies in candidemia.

Keywords

Candidemia , Invasive candidiasis , Antifungal susceptibility , Candida

Kandidemi Olgularında Tür Dağılımı, Antifungal Duyarlılık ve Mortalitenin Değerlendirilmesi

https://izlik.org/JA75XL76YH

Abstract

Amaç: Bu çalışmada, bir yıllık dönemde hastanemizde saptanan kandidemi olgularında Candida türlerinin dağılımının, antifungal duyarlılık profillerinin ve 30 günlük mortalite oranlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: 01.04.2024–30.04.2025 tarihleri arasında kan kültürlerinde Candida türü izole edilen 98 kandidemi olgusu retrospektif olarak incelendi. Tür tanımlaması ve antifungal duyarlılık testleri Vitek 2 Compact otomatize sistemi ile gerçekleştirildi. Hastaların demografik verileri, Candida tür dağılımı, antifungal direnç oranları ve 30 günlük mortalite değerlendirildi.
Bulgular:Toplam 98 kandidemi olgusunun %59,1’i erkek, %40,9’u kadın olup hastaların yaş ortalaması 73,95±11,40 yıl idi. Olguların büyük çoğunluğu (%87,8) yoğun bakım ünitelerinde takip edilen hastalardan oluşmaktaydı. Candida türlerinin dağılımında C. albicans %54,1 ile en sık izole edilen etkendi.Non-albicans türler arasında en sık C. tropicalis (%18,4), ardından C. parapsilosis (%13,3), C. glabrata (%9,2), C. auris (%2,0), C. guilliermondii (%2,0) ve C. dubliniensis (%1,0) saptandı. Antifungal duyarlılık sonuçlarında Amfoterisin B direnci %1, flukonazol direnci %4,7 ve vorikonazol direnci %3,5 olarak belirlendi. Ekinokandin grubu ajanlara direnç oranı %4,2 olarak bulundu. Olguların 30 günlük mortalite oranı %63,3 (62/98) idi. Türlere göre mortalite incelendiğinde, türler arasında istatistiksel olarak anlamlı bir fark saptanmadı (p=0,25). Mortalite gelişen hastaların yaş ortalaması (76,4±10,46), sağ kalanlara (69,66±11,81) göre anlamlı derecede yüksekti (p=0,006). Erkeklerde mortalite kadınlara göre daha yüksek bulunmakla birlikte fark istatistiksel olarak anlamlı değildi ( p=0,23).
Sonuç: Tür dağılımı, antifungal direnç ve mortalite verilerinin kapsamlı değerlendirilmesi, kandidemi yönetiminde hasta sonuçlarını iyileştirmek ve tedavi stratejilerini geliştirmek için önemlidir.

Keywords

Kandidemi , İnvaziv kandidiyazis , Antifungal duyarlılık , Candida

References

• Pouresmaeil O, Keikha M, Sankian M, Aryan E, Meshkat Z, Youssefi M, et al. An In-house PCR Workflow for Rapid Detection of Candida spp. from Blood Cultures of Septicemia Suspected Patients. Middle East Journal of Rehabilitation and Health Studies. 2025;12(12):e165610.
• Mirza A, Senol E, Kalkanci A. Epidemiology and Risk Factors of Candidemia Among Hospitalized Patients in a Turkish Tertiary Care Hospital. Clinical Laboratory. 2022;68(1).
• ÇALIŞKAN E, DEDE A, GÜVEN GB. KAN KÜLTÜRLERİNDE SAPTANAN CANDIDA TÜRLERİNİN DAĞILIMI VE ANTİFUNGAL DUYARLILIKLARI. ANKEM Derg. 2013;27(1):25-30.
• Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clinical infectious diseases. 2006;43(1):25-31.
• Cornely O, Bassetti M, Calandra T, Garbino J, Kullberg B, Lortholary O, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non‐neutropenic adult patients. Clinical Microbiology and Infection. 2012;18:19-37.
• Stewart AG, Laupland KB, Edwards F, Koo S, Hammond SP, Harris PN, et al. Population-based longitudinal study over two decades of Candida and Candida-like species bloodstream infection reveals gender and species differences in mortality, recurrence and resistance. Journal of Infection. 2025;91(1):106513.
• Epelbaum O, Chasan R. Candidemia in the intensive care unit. Clinics in Chest Medicine. 2017;38(3):493-509.
• KILINÇEL Ö, AKAR N, KARAMURAT ZD, ÇALIŞKAN E, ÖKSÜZ Ş, ÖZTÜRK CE, et al. Kan Kültürlerinden İzole Edilen CandidaTürlerinin Dağılımı ve Antifungal Duyarlılıkları.
• Tosun Mİ, Kirişci Ö. KAN KÜLTÜRLERİNDE TESPİT EDİLEN CANDIDA İZOLATLARININ DAĞILIMI VE ANTİFUNGAL DUYARLILIKLARININ TİCARİ BİR SIVI MİKRODİLÜSYON TESTİ İLE BELİRLENMESİ. ANKEM Dergisi. 2024;38(2):53-61.
• Er H, Yılmaz NÖ, Derici YK, Hancı S, Çopur ŞS. Kandidemi Etkenlerinin Tür Dağılımı ve Duyarlılıkları: Hastanemizde Ampirik Antifungal Tedavi Politikası Değiştirilmeli mi? Turk Mikrobiyol Cemiy Derg. 2021;51(2):150-5.
• Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. International Journal of Infectious Diseases. 2010;14(11):e954-e66.
• Ergon M, Dereli M, Ener B, Atalay M, Koç A, Çerikçioğlu N, et al. Türkiye’de altı yıllık zaman dilimi içerisinde kan kültürlerinden soyutlanan maya mantarlarının tür dağılımı: çok merkezli bir çalışma. Mikrobiyol Bul. 2020;54(4):638-46.
• Bassetti M, Merelli M, Righi E, Diaz-Martin A, Rosello EM, Luzzati R, et al. Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain. Journal of clinical microbiology. 2013;51(12):4167-72.
• Kim HY, Nguyen TA, Kidd S, Chambers J, Alastruey-Izquierdo A, Shin J-H, et al. Candida auris—a systematic review to inform the World Health Organization fungal priority pathogens list. Medical Mycology. 2024;62(6):myae042.
• Sears D, Schwartz BS. Candida auris: An emerging multidrug-resistant pathogen. International Journal of Infectious Diseases. 2017;63:95-8.
• Kilbas I, Kahraman Kilbas EP, Horhat FG, Ciftci IH. Twenty-Year Course of Antifungal Resistance in Candida albicans in Türkiye: A Systematic Review and Meta-Analysis. Journal of Fungi. 2025;11(8):603.
• Díaz-García J, Machado M, Alcalá L, Reigadas E, Pérez-Ayala A, Gómez-García de la Pedrosa E, et al. Trends in antifungal resistance in Candida from a multicenter study conducted in Madrid (CANDIMAD study): fluconazole-resistant C. parapsilosis spreading has gained traction in 2022. Antimicrobial agents and chemotherapy. 2023;67(11):e00986-23.
• Yamin D, Akanmu MH, Al Mutair A, Alhumaid S, Rabaan AA, Hajissa K. Global prevalence of antifungal-resistant Candida parapsilosis: a systematic review and meta-analysis. Tropical Medicine and Infectious Disease. 2022;7(8):188.
• Erdem F, Tuncer E, Oral B, Karakoç E, Demiröz AP, Tülek N. Candida türlerine bağlı nozokomiyal enfeksiyonların epidemiyolojik ve mikrobiyolojik açıdan değerlendirilmesi. Mikrobiyol Bul. 2012;46(4):637-48.
• Cilo BD. Species distribution and antifungal susceptibilities of Candida species isolated from blood culture. Cureus. 2023;15(4).
• Arikan-Akdagli S, Gülmez D, Doğan Ö, Çerikçioğlu N, Dereli MD, Birinci A, et al. First multicentre report of in vitro resistance rates in candidaemia isolates in Turkey. Journal of global antimicrobial resistance. 2019;18:230-4.
• Bassetti M, Giacobbe DR, Vena A, Trucchi C, Ansaldi F, Antonelli M, et al. Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project. Critical Care. 2019;23(1):219.
• Araujo JM, de Almeida Junior JN, Magri MMC, Costa SF, Guimarães T. Epidemiological Assessment and Risk Factors for Mortality of Bloodstream Infections by Candida sp. and the Impact of the COVID-19 Pandemic Era. Journal of Fungi. 2024;10(4):268.
• Ünal N, Karakoyun AS, Ünal İ, Turunç T, Lass-Flörl C, Ilkit M. Epidemiological Characteristics and Mortality Predictors of Candidemia Due to Candida albicans: A Single-Center Experience from Türkiye. Journal of Fungi. 2025;11(11):788.
• Kutlu M, Sayın-Kutlu S, Alp-Çavuş S, Öztürk ŞB, Taşbakan M, Özhak B, et al. Mortality-associated factors of candidemia: a multi-center prospective cohort in Turkey. European Journal of Clinical Microbiology & Infectious Diseases. 2022;41(4):597-607.
• Zhang C, Wu S, Chen X, Yang H, Feng W, Yuan T, et al. Clinical manifestations and treatment of candidemia caused by different Candida species: a retrospective study. BMC Infectious Diseases. 2024;24(1):1234.
• Kwon YJ, Won EJ, Jeong SH, Shin KS, Shin JH, Kim YR, et al. Dynamics and predictors of mortality due to candidemia caused by different Candida species: comparison of intensive care unit-associated candidemia (ICUAC) and non-ICUAC. Journal of Fungi. 2021;7(8):597.
• Hesstvedt L, Gaustad P, Müller F, Torp Andersen C, Brunborg C, Mylvaganam H, et al. The impact of age on risk assessment, therapeutic practice and outcome in candidemia. Infectious Diseases. 2019;51(6):425-34
• Puig-Asensio M, Padilla B, Garnacho-Montero J, Zaragoza O, Aguado J, Zaragoza R, et al. Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: a population-based surveillance in Spain. Clinical Microbiology and Infection. 2014;20(4):O245-O54.