Candidemia in a General Hospital in Kuwait: Epidemiology, Species Distribution, Risk Factors, and Antifungal Susceptibility Patterns over a 10-Year Period (2015–2024)

This 10-year retrospective observational study (2015-2024) conducted at Al-Amiri Hospital in Kuwait aimed to analyze the epidemiology, species distribution, and key risk factors associated with <i>Candida</i> bloodstream infections. Data were collected on patient demographics and clinical risk factors, and the distribution of <i>Candida</i> species was determined based on isolates recovered from patients with confirmed candidemia. Multivariate logistic regression was performed to identify factors associated with candidemia outcomes. Cases significantly increased from 33 (2015-2016) to 93 (2023-2024), predominantly affecting elderly patients (≥65 years) and intensive care unit (ICU) admissions. A shift in species distribution was observed, with a decline in <i>Candida albicans</i> and a marked increase in <i>Candidozyma auris</i> (formerly <i>Candida auris</i>) and <i>C. parapsilosis</i>. Antifungal susceptibility patterns were species-specific: <i>C. albicans</i>, <i>C. parapsilosis</i>, and <i>C. tropicalis</i> remained highly susceptible to all tested antifungals, while <i>Nakaseomyces glabratus</i> (formerly <i>Candida glabrata)</i> showed fluconazole resistance in 25% of isolates. <i>C. auris</i> exhibited resistance to fluconazole (97%) and variable resistance to echinocandins and voriconazole. Echinocandins retained broad-spectrum activity across most species. Independent risk factors included ICU admission, advanced age, and comorbidities. <i>N. glabratus</i> and <i>C. auris</i> infections were linked to higher mortality. This study highlights the growing candidemia burden in Kuwait, driven by emerging non-<i>albicans Candida</i> (NAC) spp. and related species. Early species identification and susceptibility testing are crucial for effective treatment and improved outcomes, necessitating enhanced infection control and antifungal stewardship.