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June 21, 2026Open Access

Epidemiology, Antifungal Susceptibility, and in-Hospital Mortality of Candidemia in a Tertiary Hospital of China: A 10-Year Retrospective Analysis

Key Points

This study aims to analyze the epidemiology and risk factors for in-hospital mortality associated with candidemia.
Retrospective enrollment of 387 inpatients with candidemia from 2015 to 2024.
Analysis of species distribution, clinical characteristics, and antifungal susceptibility.
Cox regression used to identify independent risk factors for in-hospital mortality.
Cumulative incidence of candidemia was 0.214 per 1,000 inpatients with 33.85% in-hospital mortality.
Age ≥ 63 years (HR = 1.530, 95% CI: 1.077–2.174, P=0.018), ICU admission (HR = 2.005, 95% CI: 1.200–3.350, P=0.008), and renal failure (HR = 1.849, 95% CI: 1.261–2.711, P=0.002) were risk factors.
C. albicans was most prevalent (31.27%) and showed high susceptibility to antifungals, whereas C. tropicalis had higher resistance rates.

Abstract

Purpose: In response to the increasing incidence of candidemia, this study aimed to investigate its epidemiology and risk factors for in-hospital mortality in an eastern Chinese tertiary hospital, thereby guiding clinical management. Patients and Methods: We retrospectively enrolled 387 inpatients with candidemia (2015– 2024). Species distribution, clinical characteristics, and antifungal susceptibility were analyzed. Cox regression model was used to identify independent risk factors for in-hospital mortality. Results: The cumulative incidence of candidemia was 0.214 per 1,000 inpatients, with an overall in-hospital mortality of 33.85%. The intensive care unit (ICU) was the primary patient location (55.30%). Candida albicans remained the predominant pathogen (31.27%), followed by Candida glabrata (25.58%), Candida parapsilosis complex (21.44%), and Candida tropicalis (18.60%). Ward-specific analysis showed that C. albicans was most frequent in the ICU (34.11%) and infectious disease wards (50.00%), whereas C. glabrata predominated in urology (52.17%) and pancreatic surgery (41.18%) wards. In Hematology, C. tropicalis was the primary pathogen (66.67%). Most of C. albicans and C. parapsilosis were susceptible (> 90%) to all nine antifungals; while C. tropicalis exhibited relatively high resistance/non-wild-type (18.06%– 69.44%) to four azoles, with 27.78% cross-resistance to fluconazole and voriconazole. Age ≥ 63 years ( HR = 1.530, 95% CI : 1.077– 2.174, P = 0.018), ICU admission ( HR = 2.005, 95% CI : 1.200– 3.350, P = 0.008), and acute or chronic renal failure ( HR = 1.849, 95% CI : 1.261– 2.711, P = 0.002) were identified as independent risk factors, whereas C. parapsilosis complex infection ( HR = 0.456, 95% CI : 0.275– 0.756, P = 0.002) and antifungal therapy ( HR = 0.313, 95% CI : 0.194– 0.505, P = 0.001) were independently associated with lower risks. Conclusion: C. albicans was the predominant cause of candidemia in our institute. Given its high incidence and mortality, it was imperative to develop tailored management and prevention strategies based on the local pathogen profile, antifungal susceptibility patterns, and specific mortality risk factors. Attention should focus on high-risk patients to improve clinical outcomes. Keywords: candidemia, epidemiology, species distribution, drug resistance, in-hospital mortality, risk factors

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