Species Distribution and Resistance Mechanisms of Candida Isolates in Candidemia: Insights into the Rise of Candida auris

Objectives: Candida species have emerged as significant nosocomial pathogens, particularly in intensive care settings, with Candida auris posing an increasingly severe global public health threat due to its multidrug resistance and potential for outbreaks. This study aimed to investigate the species distribution, antifungal resistance patterns, and virulence traits of Candida isolates in bloodstream infections (BSIs), with a focus on C . auris . Materials and Methods: A prospective observational study was conducted over 18 months in the Tertiary Care Teaching Hospital of western Maharashtra, India, involving 127 patients with culture-confirmed candidemia. All isolates were identified using conventional and/or automated systems, with molecular confirmation of C . auris along with several resistance genes detection ( erg11 , fks1 ) via polymerase chain reaction. Antifungal susceptibility testing was performed using VITEK 2 for all Candida isolates. Phenotypic assays for virulence factors were performed to assess biofilm formation. Results: Among all candidemia cases, Candida tropicalis (37.8%) was the most prevalent species, followed by C . auris (18.1%), Candida albicans (15.7%), and Candida glabrata (11%). High rates of fluconazole resistance were noted, particularly in C . auris (100%) and C . glabrata . Echinocandin resistance was not seen, but it is concerning in C . auris . Biofilm formation was detected in most C . auris (98%) isolates. The erg11 gene was detected in all azole-resistant C . auris isolates. Conclusion: This study highlights a shift toward nonalbicans Candida , especially C . auris , in BSIs and underscores the urgent need for early detection, antifungal resistance surveillance, and stringent infection control practices. The integration of molecular diagnostics and stewardship programs is imperative for improving patient outcomes and limiting nosocomial transmission.