Hospitalizations involving Candida parapsilosis bloodstream infection, United States, 2016–2024

Candidemia is a common healthcare-associated infection associated with substantial morbidity and mortality. Candida parapsilosis is among the most common causative species; it has a notable ability to form biofilms and colonize skin, facilitating patient-to-patient spread, and it is increasingly associated with fluconazole resistance. We aimed to describe temporal trends, clinical characteristics, and antifungal resistance patterns among C. parapsilosis candidemia hospitalizations in the United States during 2016–2024. We used the Premier Healthcare Database (which represents > 500 hospitals contributing laboratory data) to identify hospitalizations with ≥ 1 blood culture positive for C. parapsilosis. We calculated rates of C. parapsilosis candidemia hospitalizations and described characteristics overall and stratified by time period (2016–2019, 2020–2021, 2022–2024). We also compared characteristics of hospitalizations with vs. without fluconazole resistance. Among 1 943 C. parapsilosis candidemia hospitalizations, prevalence peaked during the COVID-19 pandemic (10.4 per 100 000 hospitalizations in 2020–2021) and was highest among adults aged 45–64 years, male patients, and non-Hispanic Black patients. Many hospitalizations involved intensive care unit admission (67%), central venous catheter use (51%), and mechanical ventilation (37%). Fluconazole resistance rates increased from 3.1% in 2016–2019 to 11.7% in 2022–2024. In-hospital death or discharge to hospice was more frequent among hospitalizations involving fluconazole-resistant isolates vs. those without fluconazole-resistant isolates (42% vs. 28%, p = 0.017). Increased fluconazole resistance in C. parapsilosis is a growing public health concern. Surveillance, infection prevention and control practices, and routine antifungal susceptibility testing are essential to inform clinical management and public health strategies.