ICU-Acquired Candidemia: Epidemiological Trends, Risk Factors, Antifungal Resistance, and Clinical Outcomes in a Tertiary Care Centre in India

Abstract

Background: Candidemia represents a major nosocomial threat in ICU settings, leading to significant morbidity and mortality. With the rise in non-albicans Candida (NAC) species and antifungal resistance, early diagnosis and targeted management are imperative.

Objective: This study aimed to determine the epidemiological profile, risk factors, antifungal susceptibility patterns, and outcomes of candidemia in ICU patients in a tertiary care hospital in India.

Methods: A prospective observational study was conducted on 66 ICU patients diagnosed with candidemia from May 2023 to October 2024. Data on demographics, clinical parameters, interventions, and laboratory values were collected. Candida species identification and antifungal susceptibility testing were performed. Outcomes were compared based on the timing of antifungal therapy initiation.

Results: Among 438 ICU admissions, 32 patients (7.3%) were confirmed to have candidemia. Candida tropicalis (43.75%) was the most common isolate, followed by C. albicans and C. krusei. Risk factors included broad-spectrum antibiotic use (65.2%), immunosuppression (62.1%), and use of invasive devices. Fluconazole resistance was observed in 50% of isolates. Early antifungal treatment (within 48 hours) significantly reduced mortality (10% vs. 41.7%).

Conclusion: ICU-acquired candidemia is increasingly caused by NAC species with substantial antifungal resistance. Early diagnosis, prompt therapy, and species-level identification are critical to improve outcomes.