Evolving Epidemiology of Invasive Candidiasis in Southwest China: A Four-year Analysis of Species Distribution, Antifungal Resistance Profiles, and Mortality Risk Factors

Purpose: The purpose of this study was to explore the strain distribution, clinical characteristics, antifungal sensitivity and risk factors of 30-day mortality of invasive Candida infection of hospitalized patients. Patients and Methods: We conducted a four-year retrospective study at a tertiary teaching hospital in Southwest China, enrolling non-duplicate strains isolated from invasive candidiasis samples obtained from hospitalized patients. Results: Of the 345 non-duplicate invasive candidiasis cases, 145 (42%) were candidemia cases. Candida albicans (44.3%) was the most identified species, followed by C. glabrata (18.2%), C. tropicalis (14.5%), and C. parapsilosis (12.5%). Amphotericin B and echinocandins demonstrated potent in vitro activity, whereas Candida species exhibited high resistance rates to azole antifungals, particularly C. tropicalis , whose resistance rate approaches 30%. Compared to patients in general wards, ICU patients exhibited more severe clinical symptoms, higher rates of invasive medical procedures and antibiotic exposure. Multivariate analysis identified hepatobiliary disease, surgical interventions within 6 months, tracheal intubation, ICU admission, and use of aminoglycosides and tetracyclines as independent risk factors for 30-day mortality. Additionally, the study revealed that elevated levels of BDG, and IL-6, as well as reduced PLT, were associated with increased 30-day mortality. Conclusion: A better understanding of the specific risk factors associated with ICU stays could facilitate earlier identification of high-risk candidates for antifungal therapy initiation, thereby improving clinical outcomes for critically ill patients with invasive candidiasis. Keywords: invasive candidiasis, strain distribution, antifungal drug susceptibility, risk factors