Yeast infections in sterile body fluids: species distribution, antifungal susceptibility, and cross-cutting risk factors for fungemia, sepsis, and mortality (2019–2023)

Background Yeast infections from sterile body fluids are increasingly encountered in tertiary care, yet contemporary links between species ecology, antifungal susceptibility, and patient outcomes remain underdefined. Methods We conducted a retrospective cohort study of 231 consecutive sterile-site yeast isolates at Nanjing Drum Tower Hospital (2019–2023). Species were identified by CHROMagar and MALDI-TOF MS; antifungal MICs were determined using YeastOne and interpreted by CLSI M27-Ed3. Clinical data were abstracted from electronic records. Variables with p 0.10 in univariate testing entered multivariable logistic regression to identify independent predictors of fungemia, sepsis, and in-hospital mortality. Results The four major Candida species showed distinct susceptibility profiles, with C. albicans broadly susceptible, C. tropicalis exhibiting notable azole resistance, Nakaseomyces glabratus ( C. glabrata ) displaying high azole MICs but good echinocandin activity, and C. parapsilosis maintaining low azole MICs but intrinsically higher echinocandin MICs. Clinically, bloodstream involvement was frequent. Fungemia was independently associated with blood transfusion and hemodialysis catheterization, whereas surgery was protective (OR 0.320, 95% CI 0.171–0.599). Sepsis occurred in 23.8% and was independently associated with ICU admission (OR 7.119, 95% CI 2.811–18.026); surgical treatment again showed a protective association (OR 0.426, 95% CI 0.190–0.954). Overall mortality was 26.8%; acute kidney injury (AKI) independently predicted death (OR 3.354, 95% CI 1.563–7.198). Conclusions In this five-year cohort, Candida —led by C. albicans with a rising non-albicans share—dominated sterile-site infections. Echinocandins and amphotericin B retained broad activity, whereas azole activity was reduced in C. tropicalis/N. glabratus . Across outcomes, transfusion and hemodialysis catheters increased fungemia risk, ICU admission increased sepsis risk, AKI drove mortality, and early surgical source control was consistently protective. These findings support prompt device removal, restrictive transfusion, proactive renal management, and echinocandin-first strategies in high-risk patients.