Evolving Landscape of Candidemia in India: Species Shift, Antifungal Resistance, and Clinical Impact: Narrative review

Introduction: Candidemia has emerged as a major cause of bloodstream infections in Indian hospitals, contributing substantially to morbidity, mortality, and healthcare costs. Over the past two decades, a distinct epidemiological transition from Candida albicans to non-albicans Candida (NAC) species has been observed, accompanied by rising antifungal resistance and the emergence of Candida Auris as a multidrug-resistant pathogen. Objective: To synthesize evidence from Indian studies on the epidemiology, species distribution, antifungal susceptibility, and clinical outcomes of candidemia across adult, pediatric, and neonatal populations. Methods: A narrative review was conducted using PubMed, Scopus, Ended, and Google Scholar for English-language publications from 2000–2024. Studies describing laboratory-confirmed candidemia in India were included and analyzed for regional trends, resistance profiles, and patient outcomes. Results: Across more than three decades of surveillance, C. tropicalis and C. parasitosis have replaced C. albicans as predominant isolates, particularly in intensive-care, oncology, and neonatal settings. Fluconazole resistance among NAC species is increasing, while C. auris demonstrates multidrug resistance and frequent ICU-associated outbreaks. Reported mortality rates range from 30 to 60 percent, highest in neonates and immunocompromised patients. Delayed diagnosis, empirical azole use, and limited antifungal stewardship amplify disease burden. Conclusion: Candidemia in India represents an evolving public-health challenge driven by NAC predominance and escalating antifungal resistance. Strengthening mycology laboratories, incorporating species-level identification, and integrating fungal surveillance into national AMR programs are imperative for early detection, rational therapy, and improved patient survival.