Candida and candidemia in Korea

Purpose: Candidemia is a common cause of nosocomial bloodstream infections associated with high mortality rates. Its incidence varies significantly across countries and hospitals, and its epidemiology is a subject of continuous investigation. This review aims to provide a comprehensive analysis of candidemia in Korea, addressing its changing epidemiology, species distribution, antifungal resistance, and clinical implications. Current content: In Korea, Candida albicans remains the most common isolate in blood cultures; however, infections caused by non-albicans Candida species are increasing. The 30day mortality rates for patients with candidemia vary considerably across different Candida species, with Candida tropicalis at 47.0%, C. albicans at 36.4%, Candida glabrata at 34.7%, and Candida parapsilosis at 22.5%. Recent Korean studies have highlighted the clonal spread of bloodstream infections caused by C. parapsilosis with the Erg11p Y132F mutation, and certain isolates are becoming endemic to specific healthcare settings. C. glabrata poses a significant threat; this species is increasingly resistant to antifungal medications and multidrug-resistant isolates are emerging. Whole-genome sequencing analysis elucidates the transmission dynamics of clonal bloodstream isolates of C. glabrata among patients receiving antifungal therapy. This analysis demonstrates varying degrees of fluconazole susceptibility and distinct Pdr1p mutation profiles, identifying the molecular mechanisms underlying multidrug resistance. Furthermore, the first nosocomial outbreak of Candida auris underscores the importance of multicenter surveillance for identifying and managing C. auris outbreaks. Conclusion: The changing epidemiology of candidemia, along with the continued emergence of antifungal resistance among bloodstream isolates of non-albicans Candida species warrants continuous monitoring of candidemia in Korea. By integrating clinical, microbiological, and public health perspectives, healthcare systems can develop robust strategies to optimize therapeutic approaches, prevent nosocomial transmission, and ultimately reduce morbidity and mortality associated with these life-threatening infections.