Dongting Yao,1,2,* Jia Chen,3,* Guanyi Zhang3 

1Department of Laboratory Medicine, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, People’s Republic of China; 2Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, People’s Republic of China; 3Department of Laboratory Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Guanyi Zhang, Department of Laboratory Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, People’s Republic of China, Tel/Fax +86-021-64385700, Email zhangguanyi1233@163.com Dongting Yao, Department of Laboratory Medicine, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, People’s Republic of China, Tel/Fax +86-021-64070434, Email yaodongting@126.com

Purpose: Given the increasing incidence of invasive Candida infection worldwide, particularly among immunocompromised and critically ill patients, we aimed to assess the distribution of Candida species as well as their clinical features and responses to common antifungal agents through a retrospective analysis of patient data in a Chinese traditional medicine hospital.
Patients and Methods: In this retrospective single-center study, we analyzed data from 301 patients with invasive Candida infection at our hospital between 2020 and 2022, We report the clinical characteristics, species distribution, and in-vitro susceptibility profiles of Candida isolates to eight antifungal agents. Logistic regression analysis was employed for multivariate assessments to analysis the correlation between clinical symptoms and prognosis. Kaplan–Meier survival analysis was used for survival analysis.
Results: Candida albicans was the most prevalent species (38.9%, 117/301), followed by C. tropicalis (28.2%, 85/301) and C. glabrata (22.9%, 69/301). Age, department of admission, underlying disease, and presence of risk factors differed significantly among patients with different Candida infections. Kaplan–Meier survival analysis showed that C. krusei infection was associated with a higher seven-day mortality than other Candida spp. infections. Multivariate logistic regression analyses showed that age, presence of sepsis, insertion of the central venous catheter, and administration of total parenteral nutrition were independent predictors of mortality. C. tropicalis was most resistant to azoles, with 36.26% of the strains being fluconazole-resistant, 35.16% being non-wild type to itraconazole, and 34.52% being non-wild type to voriconazole. Non-susceptibility to echinocandins was found in 11 C. glabrata strains (10.39%, 3.90%, and 1.30% of isolates for caspofungin, micafungin, and anidulafungin, respectively).
Conclusion: Our findings underscore the need for close monitoring of azole resistance in C. tropicalis and echinocandin resistance in C. glabrata, and highlight age, sepsis, CVC insertion, and parenteral nutrition as key predictors of mortality in invasive Candida infections.

Keywords: fungal disease, resistant, azoles, echinocandins