Epidemiology, risk factors, and mortality of Candida bloodstream infection in Yulin, China: a 7-year retrospective study

Candida bloodstream infection (BSI) causes substantial morbidity and mortality in hospitalized patients, and its epidemiology may vary across resource-limited settings. We described Candida species distribution in candidemia patients in Yulin, China, and assessed factors associated with species patterns and predictors of 28-day mortality to support risk stratification and clinical management. We retrospectively included patients with a first episode of candidemia at The First People’s Hospital of Yulin (2018–2024), collecting demographic, clinical, laboratory, and treatment data. Factors associated with C. albicans (vs non-albicans) candidemia were evaluated using univariate tests and multivariable logistic regression, and predictors of 28-day mortality were assessed with Cox models and Kaplan–Meier analyses. A total of 565 patients were included; 64.1% were male, and the median age was 65 years (IQR, 55–73). C. albicans was the most common species (45.7%, 258/565), while non-albicans Candida accounted for 54.3%, mainly C. glabrata (16.6%), C. tropicalis (16.5%), and the C. parapsilosis complex (15.0%). From 2018 to 2024, the overall number of isolates increased, with a progressive shift toward non-albicans Candida species. Mechanical ventilation was an independent risk factor for C. albicans BSI (OR = 1.748, 95% CI 1.225–2.495). The 28-day mortality rate was 21.9% (124/565). Independent risk factors for 28-day mortality included solid organ malignancy (aHR = 2.429, 95% CI 1.435–4.111), coronary heart disease (aHR = 1.610, 95% CI 1.079–2.403), digestive system diseases (aHR = 1.510, 95% CI 1.048–2.176), clavicular vein catheterization (aHR = 1.666, 95% CI 1.082–2.566), mechanical ventilation (aHR = 2.080, 95% CI 1.297–3.334), and hemodialysis (aHR = 1.724, 95% CI 1.168–2.546). Patients who received antifungal therapy showed higher observed survival than those who did not (log-rank p < 0.001), whereas patients with central venous catheterization showed lower observed survival than those without (log-rank p = 0.009). Candidemia in Yulin was mainly caused by C. albicans, with a rising contribution from non-albicans species. Mechanical ventilation was associated with C. albicans candidemia, and gastrointestinal diseases, mechanical ventilation, and hemodialysis were linked to higher 28-day mortality. Enhanced risk-based surveillance and timely guideline-concordant management may improve outcomes, but prospective studies are needed to confirm these findings.