Nine-Year Surveillance of Candida parapsilosis Candidemia in a Cardiothoracic ICU: Insights into Mortality and Resistance

<i>Candida parapsilosis</i> has emerged as a prominent cause of nosocomial candidemia, particularly among critically ill patients. The increasing prevalence of fluconazole-resistant <i>C. parapsilosis</i> (FR-Cp) poses major therapeutic challenges, especially in resource-limited settings. We conducted a retrospective study of 144 patients with <i>C. parapsilosis</i> candidemia admitted to two post-surgical ICUs at a Brazilian tertiary cardiothoracic hospital between 2016 and August 2024. Demographic, clinical, microbiological, and therapeutic data were analyzed. Predictors of 30-day mortality were identified through multivariate logistic regression. The incidence density of <i>C. parapsilosis</i> candidemia ranged from 2.93 to 8.31 per 1000 hospitalizations. Fluconazole resistance was identified in 81% of isolates. Overall 30-day mortality was 55%. Independent risk factors for mortality included cardiopathy (OR: 19.36, <i>p</i> = 0.006), higher SOFA scores (OR: 1.54, <i>p</i> = 0.003), parenteral nutrition (OR: 29.77, <i>p</i> = 0.013), and dialysis (OR: 6.59, <i>p</i> = 0.043), while longer treatment duration was protective (OR: 0.81, <i>p</i> < 0.001). Fluconazole resistance was not independently associated with increased mortality. In this cohort of critically ill patients, <i>C. parapsilosis</i> candidemia was associated with high mortality and a high prevalence of fluconazole resistance. Clinical outcomes were mainly driven by host-related and therapeutic factors rather than antifungal resistance alone.