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. 2025 Jul 22:16:1630226.
doi: 10.3389/fmicb.2025.1630226. eCollection 2025.

Epidemiology risk factors and antifungal resistance patterns of Candida in cancer patients in Jiangxi China

Hazrat Bilal  1 , Xiaohui Li  1 , Xunsong Wang  2 , Muhammad Nadeem Khan  3 , Muhammad Shafiq  4 , Jiamei Yu  1 , Hanman Qiu  1 , Qiao-Li Lv  1 , Bin Xu  1
Affiliations

Epidemiology risk factors and antifungal resistance patterns of Candida in cancer patients in Jiangxi China

Hazrat Bilal et al. Front Microbiol. .

Abstract

Background: Candidiasis in cancer patients remains largely unexplored in China. This study examines risk factors and antifungal susceptibility patterns of Candida in cancer patients from Jiangxi, China.

Methods: Clinical and demographic data on Candida in cancer patients (2018-2024) were retrospectively collected at Jiangxi Cancer Hospital, Nanchang, China. Candida distribution across cancers and antifungal susceptibility patterns were analyzed. Risk factors were identified via logistic regression, and antifungal consumption was correlated with Candida distribution. Survival probabilities were compared between patients with C. albicans and those with non-albicans Candida (NAC) infections.

Results: Among 2,761 Candida isolates, 1,703 (61.68%) were C. albicans and 1,058 (38.31%) were NAC, with a year-wise trend showing a decline in C. albicans and a rise in NAC. C. albicans was significantly higher in lung (40.57%) and nasopharyngeal (11.33%) cancers, while NAC were more common in gastric (7.56%), colon (8.69%), and urogenital (14.65%) cancers. NAC risk factors included inappropriate empirical therapy (OR 13.8, P < 0.001), hypoproteinemia (OR 1.35), anemia (OR 1.28), urinary tract infection (OR 1.71), and indwelling catheters (OR 1.27) (all P < 0.05). Radiotherapy, targeted therapy, glucocorticoids, chest tube insertion, and parenteral nutrition were associated with C. albicans (P ≤ 0.01). Amphotericin B (>99%) and echinocandins (>96%) showed the highest efficacy. C. tropicalis displayed notable azole resistance (40.9-74.45%). Caspofungin use negatively correlated with C. albicans (r = -0.84, P = 0.02) and positively with C. tropicalis (r = 0.78, P = 0.04) and N. glabrata (r = 0.85, p = 0.02). NAC infections showed 1.5-fold higher mortality rate than C. albicans (95% CI: 1.1-2.0; P = 0.0075).

Conclusion: These findings may aid healthcare officials in improving Candida management in the region and similar settings.

Keywords: Candida species; antifungal consumption; antifungal resistance; cancer patients; epidemiology and risk factors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Line and bar charts displaying incidence and proportion of various Candida species from 2018 to 2024. Chart (a) shows incidence per 1,000 admissions with lines for each species; Candida albicans and total incidence are notable. Chart (b) indicates proportion percentages, with Nakaseomyces glabrata consistently prominent, followed by fluctuations in Candida albicans and other species.
FIGURE 1
Year-wise occurrence of Candida species in the current study, (a) incidence per 1,000 admissions; (b) proportions of Candida species.
Bar charts depict the proportion of different Candida and related fungal species in various cancer types. Each chart represents a different species: Candida albicans, Candida tropicalis, Nakaseomyces glabrata, Candida parapsilosis, Pichia kudriavzevii, Clavispora lusitaniae, and Meyerozyma guilliermondii. The proportions are shown in percentages, with different colors indicating cancer types such as bone, brain, lung, and others. A legend correlates colors to specific cancer types.
FIGURE 2
Proportion of different Candida species in various cancer types. Each species’ proportion in each cancer type is written at the top of each bar.
Bar graph comparing the percentages of Candida albicans and non-albicans Candida infections across different body sites. Candida albicans shows a higher prevalence in the lung and nasopharyngeal areas, while non-albicans Candida shows a notable presence in thymoma. Data labels indicate statistical significance, with Candida albicans having a greater presence overall.
FIGURE 3
Comparative analysis of C. albicans and non-albicans Candida across cancer types. Species counts are shown above each bar, with significant p-values indicated above the corresponding cancer types.
Kaplan-Meier survival curve showing survival probability over time in days. The yellow line represents *C. albicans* group, and the blue line represents non-*albicans C* group. Both groups show a gradual decline in survival, with non-*albicans C* having a slightly better survival probability. A significant difference is noted with a p-value of 0.0075. Shaded areas indicate confidence intervals for each group.
FIGURE 4
Kaplan-Meier survival curve analysis of C. albicans versus non-albicans Candida group.
Hazard ratio graph comparing mortality between C. albicans (reference, N=1703) and non-albicans Candida (N=1058). The hazard ratio for non-albicans is 1.5 with a confidence interval of 1.1 to 2. A significant p-value of 0.008 is indicated. Events: 193; Concordance Index: 0.56; AIC: 2829.03.
FIGURE 5
Cox proportional hazards analysis of mortality risk between Candida albicans and non-albicans Candida groups. #; Numbers, **; Significant.
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