# Trends and Characteristics of Candidemia in Patients With Suspected Sepsis: A Two-Year Retrospective Study From a Tertiary Hospital in Uttarakhand

## TL;DR

This study analyzed candidemia in sepsis patients at a hospital in Uttarakhand, finding a rise in non-albicans Candida species and highlighting the importance of species-specific antifungal testing.

## Contribution

The study provides localized epidemiological data on candidemia in sepsis patients, emphasizing shifts in Candida species distribution and antifungal resistance patterns.

## Key findings

- Non-albicans Candida species, especially C. tropicalis and C. pelliculosa, were predominant in candidemia cases.
- Fluconazole resistance was highest in C. krusei and C. auris, while echinocandin resistance was observed in C. glabrata.
- C. tropicalis was significantly associated with chronic kidney disease, and C. pelliculosa was predominant in neonates.

## Abstract

Introduction

Candidemia is a significant cause of morbidity and mortality in patients with sepsis, particularly in tertiary care settings. Shifts in Candida species distribution and antifungal resistance underscore the need for localized epidemiological surveillance.

Aim and objective

This study aimed to evaluate the prevalence, species distribution, clinical risk factors, and antifungal susceptibility patterns of Candida isolates in sepsis patients admitted to a tertiary care hospital in Uttarakhand, India.

Methods

A retrospective observational study was conducted from February 2022 to January 2024. Blood culture records of 17,712 sepsis patients were reviewed, among which 312 cases of candidemia were identified. Blood cultures were processed using the BAC-T ALERT system, and isolates were identified to the species level using conventional microbiological methods and the Vitek-2 system. Antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Relevant demographic, clinical, and risk factor data were extracted and statistically analyzed using SPSS version 26.0. Associations between Candida species and clinical variables were evaluated, with p-values < 0.05 considered statistically significant.

Results

The prevalence of candidemia among sepsis patients was 1.76% (312/17,712), with a mean age of 37.7 years and a male-to-female ratio of 1.72:1. Non-albicans Candida species predominated, led by C. tropicalis 84 (26.9%), followed by C. albicans 68 (21.8%), C. parapsilosis 58 (18.6%), and C. pelliculosa 37 (11.8%). C. tropicalis was significantly associated with chronic kidney disease: 21 (25.0%) (p = 0.00018); C. parapsilosis with low-birth-weight neonates: 15 (25.9%) (p = 0.00024); and C. glabrata 12 (63.2%) with diabetes mellitus (p = 0.0067). C. pelliculosa was predominant in neonates: 31 (83.8%) (p < 0.001). Most isolates were susceptible to fluconazole 284 (91.0%), voriconazole 290 (93.0%), amphotericin B 296 (94.9%), and echinocandins 300 (96.1%). Fluconazole resistance was highest in C. krusei 2/3 (66.7%) and C. auris 8/8 (100%), while echinocandin resistance was noted in C. glabrata, caspofungin 7/19 (36.8%) and micafungin 3/19 (15.8%).

Conclusion

The study highlights an epidemiological shift toward non-albicans Candida species, particularly C. tropicalis and C. pelliculosa, in candidemia cases. Routine species-level identification and antifungal susceptibility testing are crucial for guiding effective therapeutic strategies and supporting institutional antifungal stewardship.