Epidemiology, antifungal susceptibility, risk factors, and mortality of adult candidemia at a tertiary hospital in Eastern China from 2020 to 2025

This study aimed to investigate the epidemiology, antifungal resistance profiles, and risk factors for 30-day mortality in adult patients with candidemia in Eastern China, ultimately informing improved clinical management strategies. Data on clinical characteristics, blood culture isolates, and antifungal susceptibility were retrospectively collected from the laboratory information system and analyzed for adult patients with culture-confirmed candidemia from 2020 to 2025. Independent risk factors for 30-day mortality were identified using univariate and multivariate logistic regression analyses. A total of 111 candidemia cases were identified during the study period. Patients were predominantly male (68/111, 61.26%), with the largest proportion aged 60–74 years (44/111, 38.74%). Nearly half of all cases (51/111, 45.95%) were identified in the intensive care unit (ICU). Candida albicans was the most frequently isolated species (52/111, 46.85%), followed by Nakaseomyces glabratus (formerly Candida glabrata) (24/111, 21.62%), Candida parapsilosis (19/111, 17.12%), Candida tropicalis (15/111, 13.51%), and Pichia kudriavzevii (formerly Candida krusei) (1/111, 0.90%). No significant shift in species distribution was observed over the six-year period (P > 0.05). Antifungal susceptibility testing revealed that all isolates were susceptible to amphotericin B and 5-flucytosine. However, Candida tropicalis showed the highest resistance rates to voriconazole (9/15, 60.00%) and fluconazole (7/15, 46.67%). Resistance in Candida albicans was notable for itraconazole (8/52, 15.38%). The overall 30-day mortality rate was 43.24% (48/111). On multivariate analysis, cardiac disease was an independent risk factor for mortality (adjusted OR = 3.27, 95% CI: 1.36–7.88, P = 0.008). Adult Candidemia was associated with high mortality in Suzhou, China. Although Candida albicans remained predominant, the clinical burden of non-albicans species and high local resistance, especially to voriconazole in Candida tropicalis, underscored the necessity of targeted therapy. Cardiac disease was an independent predictor of mortality, emphasizing the importance of cardiovascular risk assessment, particularly in the elderly.