Nine-Year Surveillance of Candida Bloodstream Infections in a Southern Italian Tertiary Hospital: Species Distribution, Antifungal Resistance, and Stewardship Implications

<b>Purpose</b>: Candida bloodstream infections remain a major global health challenge, with mortality rates approaching 40%. Beyond classical immunocompromised status, recent evidence highlights additional risk factors, including iatrogenic immunosuppression, advanced age, prolonged hospitalization, exposure to broad-spectrum antibiotics, and total parenteral nutrition. While <i>Candida albicans</i> (<i>C. albicans</i>) remains the most common species in Europe and the USA, non-<i>albicans</i> species, particularly <i>Nakaseomyces glabratus</i> (<i>N. glabratus</i>), <i>Candida tropicalis</i> (<i>C. tropicalis</i>), and <i>Candida parapsilosis</i> (<i>C. parapsilosis</i>), are emerging worldwide. <b>Methods</b>: This retrospective observational cohort study was conducted at the University Hospital "San Giovanni di Dio e Ruggi d'Aragona" in Salerno, Italy, from January 2015 to December 2024. It included all patients with at least one positive blood culture for <i>Candida</i> species. Demographic data, hospital ward of admission, and antifungal susceptibility profiles were collected and analyzed using SPSS software (IBM SPSS Statistics for Mac, version 30 (IBM Corp., Armonk, NY, USA)). <b>Results</b>: The incidence rate is 48.7 new isolates per one thousand patient-days, with a trend of increasing episodes over time among a total of 364 patients. Most cases occurred in medical wards (59.5%), where patients were older (median age 76 (17). <i>C. albicans</i> accounted for 57.9% of isolates, and a significant association was found between species distribution and hospital unit (<i>p</i> < 0.05). Resistance to fluconazole, voriconazole, and amphotericin B increased among <i>C. albicans</i>, with similar trends in <i>N. glabratus</i> and <i>C. parapsilosis</i>. <b>Conclusions</b>: This large single-center cohort highlights both the persistent dominance of <i>C. albicans</i> and the worrisome rise in resistance among <i>C. parapsilosis</i>. Given the aging patient population and increasing antifungal resistance, local epidemiological data are crucial to guide empirical therapy. Our findings underscore the need for multidisciplinary antifungal stewardship programs to optimize personalized treatment strategies and contain the emergence of resistant strains.