# Candida species distribution, antifungal susceptibility and trends causing candidemia: a 10-year observation in eastern China

## TL;DR

This study analyzed 10 years of candidemia cases in eastern China, finding rising incidence and species-specific antifungal resistance trends.

## Contribution

The study provides updated insights into candidemia trends, species distribution, and risk factors in eastern China over a decade.

## Key findings

- Candida parapsilosis was the most prevalent species in candidemia cases.
- Candida tropicalis and Nakaseomyces glabratus showed higher resistance to itraconazole and fluconazole.
- Multiple clinical factors like diabetes, ICU admission, and surgery were identified as independent risk factors for candidemia.

## Abstract

Candidemia is a major global public health problem due to the high mortality rates and increasing antifungal resistance. This study investigated the epidemiology and risk factors of candidemia in eastern China over the past 10 years.

A descriptive, cross-sectional study was conducted from January 2015 to December 2024 in the Affiliated Hospital of Qingdao University to investigate the possible routes and risk factors of candidemia. Antifungal susceptibility was determined using broth microdilution method.

The incidence of candidemia increased from 0.98% to 1.69% over the past 10 years. In total 276 candidemia cases, Candida parapsilosis was the most prevalent species (32.2%), followed by Candida albicans (31.9%) and Candida tropicalis (21.5%). C. albicans and C. parapsilosis were susceptible to antifungal agents (resistance rate <7%). Candida tropicalis and Nakaseomyces glabratus exhibited higher resistance rates to itraconazole (18.6% and 13%) and fluconazole (18.6% and 30.4%), respectively. Multivariate analysis identified hypertension (P < 0.001), diabetes mellitus (P = 0.042), chronic pulmonary diseases (P = 0.021), hematological malignancy (P = 0.012), solid organ tumor (P = 0.031), surgery (P < 0.001), prior antibiotic administration (P < 0.001) and intravascular catheters (P = 0.03), ICU admission (P < 0.001), mechanical ventilation (P = 0.02), and total parenteral nutrition (P < 0.001) as independent risk factors of candidemia.

The incidence of candidemia has increased in recent years, with C. parapsilosis being the most prevalent species in candidemia. Effective strategies are needed to prevent candidemia from becoming a major concern.