Yeliz Özdemir, Gamze Altan, Gülfem Ece, Hüseyin Özkarakaş, Selma Tosun, Zeki Tuncel Tekgül
Eurasian Journal of Medicine and Oncology - 2025;9(4):311-321
Introduction: Candida species are increasingly recognized as significant nosocomial pathogens. In patients hospitalized in the intensive care units (ICUs), the risk of candidemia is particularly high due to the coexistence of multiple risk factors. Objective: In this study, we investigated the distribution of Candida species, antifungal susceptibility, risk factors, and mortality in ICU patients with nosocomial Candida infections. Methods: This retrospective study included 63 adult patients with candidemia hospitalized in the ICU between January 2021 and March 2023. Demographic, clinical, and laboratory data were analyzed. Statistical analysis was performed using the Chi-square test, Mann-Whitney U test, and logistic regression. Results: Non-albicans Candida (NAC) species accounted for 61.9% of all isolates, with Candida parapsilosis (42.8%) being the most common. Gastrointestinal surgery significantly increased the risk of NAC infection (p=0.038). Higher serum albumin levels were associated with a reduced risk of mortality (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.77-0.97, p=0.013), and elevated urea levels were associated with an increased risk of mortality (OR: 1.023, 95% CI: 1.008-1.038, p=0.002). All of the 16 tested isolates were susceptible to anidulafungin, while 66.6% of C. parapsilosis isolates were resistant to fluconazole. The overall mortality rate was 66.7%. Conclusions: NAC species should be considered in empirical treatment strategies, particularly for patients hospitalized in ICUs where this species is prevalent and for those with a history of gastrointestinal surgery. Low albumin and elevated urea may serve as potential predictors of mortality and should be carefully monitored. Echinocandins remain the most appropriate empirical agents given the high fluconazole resistance observed among C. parapsilosis isolates.
