Candidemia: An Update on Epidemiology, Risk Factors, Diagnosis, Susceptibility, and Treatment

Abstract

Candidemia is a highly prevalent invasive fungal infection caused primarily by C. albicans, C. parapsilosis, C. glabrata (currently Nakaseomyces glabratus), C. tropicalis, and C. krusei (currently Pichia kudriavzevii). Risk factors for the development of candidemia include steroid-induced immunosuppression used in solid organ or hematopoietic transplantation, and neutropenia secondary to infectious or tumorous processes. Alterations in the gut microbiota in people living with HIV, caused by antiretroviral therapy, increase the possibility of colonization by C. albicans. Likewise, the presence of a central venous catheter, parenteral nutrition, and abdominal surgery stand out as the main risk factors for the development of candidemia. New diagnostic tools have been developed for the diagnosis of this mycosis that allow the identification of the main species, from improvements in conventional stains such as calcofluor white, which increases sensitivity, as well as technologies such as T2 Candida, MoiM assay, biomarker panel (1,3 β-D-glucan, C-reactive protein, presepsin, and procalcitonin), and, more recently, the development of biosensors for the identification of Candida spp. Regarding treatment, the use of micafungin and anidulafungin in patients with obesity defined by a BMI > 30 kg/m² has shown higher survival rates and therapeutic success. Meanwhile, newer antifungals such as rezafungin and fosmanogepix have demonstrated excellent results in the treatment of these patients. Therefore, this review aims to update the epidemiology and risk factors of candidemia, as well as analyze the diagnostic tools and treatments currently available.

Keywords: Candida; Candida bloodstream infection; antifungal susceptibility; diagnosis; epidemiology; risk factors.

Figure 1

Global distribution of Candida species in cases of candidemia reported in the period 2020–2025.

Figure 2

Reported risk factors for the development of candidemia include immunosuppressive therapy associated with solid organ and hematopoietic stem cell transplants, as well as mutations in genes such as STAT1 and ROC, which compromise barrier immunity against Candida spp. Decreased CD28 and increased PD-1/PD-L1 markers are also present. In the context of HIV infection, CD4 suppression influences the deficiency of the immune response against Candida spp. The use of a central venous catheter is a risk factor for bloodstream infection. Furthermore, surgical intervention, particularly a history of abdominal surgery and parenteral nutrition, facilitates the colonization of Candida spp. from the digestive tract to the circulatory system. Finally, the use of antifungals and prolonged hospital stays are factors that contribute to the development of candidemia.