Distribution and Antifungal Susceptibility Profiles of Candida Species Isolated from Patients at a Romanian Tertiary Care Hospital

This study aimed to evaluate the species distribution and antifungal susceptibility profiles in Candida spp. isolates over a 17-month period in a tertiary care hospital from Bucharest, Romania. A total of 108 isolates retrieved from inpatients and outpatients were identified by MALDI-TOF and tested for susceptibility against a YO10 nine-agent panel provided by SensiTitreTM. Among the selection criteria for isolates were the sample’s origin and laboratory procedures used for antifungal testing. The MICs were interpreted according to the current CLSI breakpoints (M27M44S) and current ECVs (M57S). From a total of 92 Candida isolates with defined susceptibility breakpoints, 77 isolates (83.69%) were susceptible to fluconazole, and additionally, 11 N. glabratus (11/12, one isolate resistant) were evaluated as susceptible-dose dependent (SDD). C. albicans was the most frequently isolated species, accounting for 56.48% of all strains (61/108 isolates). Susceptibility to fluconazole in this subgroup was 86.88% (53/61 isolates). Non-albicans species were represented by a total of 47 isolates (43 with established breakpoints). The fluconazole susceptibility rate was 83.87% (26/31 isolates), notably lower than C. albicans isolates, and it was calculated by excluding N. glabratus isolates. The finding of fluconazole-resistant C. parapsilosis sensu stricto in blood cultures (3 of 6 isolates) is clinically relevant. Although this is a small exploratory comparison, the result is in line with the Southern-European signal (ECMM Candida III). Echinocandins resistance rate (Anidulafungin, Micafungin, Caspofungin) was low (2.85%, 3/105 strains with defined susceptibility cut-offs) but not alternatively documented, with MICs ranging from 1 to 4 μg/mL in two C. albicans and one C. tropicalis isolate. This study underscores the importance of tracking local epidemiological data and antifungal susceptibility patterns given the diversity of patient groups in large medical units.