Epidemiology and Clinical Features of Candida Bloodstream Infections: A 10-Year Retrospective Study in a Korean Teaching Hospital

Abstract

Candida species are major pathogens of bloodstream infections (BSIs) in hospitalized patients, with high mortality. This study examined Candida species distribution, clinical characteristics, and the mortality of patients with Candida BSIs. Adult patients (≥16 years) with Candida BSIs at a teaching hospital (2014-2023) were retrospectively reviewed. Over 10 years, 487 Candida isolates were obtained from 462 patients. C. albicans was the most frequent (38.2%), followed by C. glabrata (21.1%), C. parapsilosis (20.5%), and C. tropicalis (13.3%). The annual incidence of Candida BSIs remained stable (p = 0.525). However, non-albicans species BSIs increased 1.61-fold compared to C. albicans (95% CI: 1.19-2.19, p = 0.002). Fluconazole-non-susceptible Candida isolates increased after 2021 (p = 0.040). The overall 30-day mortality was 40.6%. In the multivariate analysis, a high Charlson comorbidity index (aHR: 1.20, 95% CI: 1.07-1.35, p = 0.001) and high SOFA score (aHR: 1.12, 95% CI: 1.02-1.23, p = 0.022) were the strongest predictors of 30-day mortality. Meanwhile, C. parapsilosis BSIs (aHR: 0.46, 95% CI: 0.22-0.99, p = 0.047) and central venous catheter removal at any time (aHR: 0.22, 95% CI: 0.13-0.37, p < 0.001) were associated with reduced 30-day mortality. The mortality of patients with Candida BSIs was mainly determined by disease severity, while catheter removal was associated with improved survival.

Keywords: Candida; candidemia; epidemiology.

Figure 1

Trends in annual incidence of Candida bloodstream infections and distribution of Candida isolates identified over the 10-year study period.

Figure 2

Kaplan–Meier survival curve showing 30-day mortality of patients with Candida bloodstream infections caused by different Candida species.