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

Introduction Candidemia is a significant cause of morbidity and mortality in patients with sepsis, particularly in tertiary care settings. Shifts in <i>Candida</i> 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 <i>Candida</i> 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 <i>Candida</i> 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-<i>albicans Candida</i> species predominated, led by <i>C. tropicalis</i> 84 (26.9%), followed by <i>C. albicans</i> 68 (21.8%), <i>C. parapsilosis</i> 58 (18.6%), and <i>C. pelliculosa</i> 37 (11.8%). <i>C. tropicalis</i> was significantly associated with chronic kidney disease: 21 (25.0%) (p = 0.00018); <i>C. parapsilosis</i> with low-birth-weight neonates: 15 (25.9%) (p = 0.00024); and <i>C. glabrata</i> 12 (63.2%) with diabetes mellitus (p = 0.0067). <i>C. pelliculosa</i> 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 <i>C. krusei</i> 2/3 (66.7%) and <i>C. auris</i> 8/8 (100%), while echinocandin resistance was noted in <i>C. glabrata, </i>caspofungin 7/19 (36.8%) and micafungin 3/19 (15.8%). Conclusion The study highlights an epidemiological shift toward non-<i>albicans Candida</i> species, particularly <i>C. tropicalis</i> and <i>C. pelliculosa</i>, in candidemia cases. Routine species-level identification and antifungal susceptibility testing are crucial for guiding effective therapeutic strategies and supporting institutional antifungal stewardship.