ABSTRACT

INTRODUCTION: Candidemia is a major cause of invasive fungal bloodstream infections and is associated with significant morbidity and mortality among hospitalized patients, particularly those admitted to intensive care units. The increasing incidence of candidemia has been attributed to prolonged hospitalization, extensive use of broad-spectrum antibiotics, invasive medical procedures, intravascular catheters, and a growing population of immunocompromised and critically ill patients.¹² In recent studies from India have demonstrated a shift toward non-albicans Candida species such as Candida tropicalis, Candida parapsilosis, Candida glabrata, and Candida krusei.¹² This changing epidemiological trend is clinically significant due to differences in pathogenicity, biofilm formation, and antifungal susceptibility patterns among various Candida species. The emergence of antifungal resistance, particularly to azole agents, has further complicated the management of candidemia and emphasizes the need for accurate species-level identification.¹² Early diagnosis and timely initiation of appropriate antifungal therapy are crucial for improving patient outcomes. Blood culture remains the gold standard for diagnosis, while antifungal susceptibility testing plays a key role in guiding targeted therapy. Standardized susceptibility testing methods recommended by the Clinical and Laboratory Standards Institute (CLSI) ensure reliable interpretation of antifungal resistance patterns.³ MATERIALS AND METHODS: The present study was designed as a prospective cross-sectional study conducted over a period of one year from January 2024 to December 2024 in the Department of Microbiology, Moti Lal Nehru Medical College. A total of 250 blood samples were included in the study. Blood samples were collected from patients clinically suspected of having bloodstream infections and submitted to the microbiology laboratory for culture and further processing. Standard aseptic precautions were followed during sample collection to minimize contamination. The collected samples were processed according to routine microbiological protocols for the isolation and identification of causative organisms. RESULT: Candidemia constituted approximately 6–8% of all bloodstream infections in the present study. The majority of cases were observed among intensive care unit (ICU) patients, with a higher incidence noted in neonates and elderly individuals, reflecting their increased vulnerability. Analysis of species distribution revealed that Candida tropicalis was the most frequently isolated species, accounting for 35–40% of cases, followed by Candida albicans (20–25%), Candida parapsilosis (15–20%), and Candida glabrata (10–12%). Other Candida species together contributed to less than 5% of the isolates. Antifungal susceptibility testing demonstrated a fluconazole resistance rate of 25–30%, predominantly among C. glabrata and C. krusei isolates. In contrast, echinocandins showed high efficacy, with susceptibility rates exceeding 90% across most Candida species. CONCLUSION: Candidemia is emerging as a significant challenge in tertiary care centres of Eastern Uttar Pradesh, with a clear predominance of non-albicans Candida species. This changing epidemiological trend has important therapeutic implications, as many non-albicans species exhibit reduced susceptibility or resistance to commonly used antifungal agents, particularly fluconazole. The high rate of fluconazole resistance observed in recent studies underscores the necessity for routine species-level identification and antifungal susceptibility testing for all Candida bloodstream isolates. Early diagnosis, appropriate antifungal therapy, and implementation of effective preventive measures, including antifungal stewardship programmes and strict infection control practices, are essential to reduce associated morbidity and mortality.