Clinical Determinants of 30-Day Mortality in Candidemia: Antifungal Susceptibility and Treatment Patterns in a 10-Year Cohort

Objective: This study aimed to identify clinically modifiable and readily accessible predictors of 30-day mortality in a 10-year candidemia cohort and to assess temporal changes in Candida species distribution. Methods: We retrospectively evaluated 391 hospitalized adults with positive blood cultures for Candida spp. between January 2015 and March 2025. Only the first candidemia episode was included. Demographic characteristics, comorbidities, risk factors, laboratory parameters, antifungal therapy, and outcomes were recorded. Species identification was performed using conventional methods and the VITEK 2 system. Factors associated with 30-day mortality were analyzed using univariate and multivariate logistic regression models. Results: The mean age was 64.5 ± 17.7 years, and 56.3% of patients were male. Most patients (68.8%) were managed in the intensive care unit, and the 30-day mortality rate was 54%. Non-albicans Candida species accounted for 62.7% of isolates, with an increasing trend over time, particularly for Candida glabrata. Fluconazole susceptibility was 79%. In univariate analysis, advanced age, solid tumors, invasive mechanical ventilation, leukocytosis, thrombocytopenia, septic shock, intensive care unit admission, and failure to remove the central venous catheter were associated with mortality. Multivariate analysis identified advanced age, intensive care unit admission, septic shock, failure to remove the central venous catheter, leukocytosis, and thrombocytopenia as independent predictors of 30-day mortality. Conclusions: Candidemia remains a life-threatening infection with high mortality. Central venous catheter management and simple hematological parameters, particularly white blood cell and platelet counts, provide practical tools for early risk stratification. Although the rising prevalence of non-albicans Candida species may require updates in empirical therapy, prompt source control remains essential to improve survival.