Epidemiology, risk factors, and in-hospital mortality of candidemia in tertiary hospital of China: A 10-year retrospective analysis from 2015 to 2024

Min Gu^1,2Chunliang Zhu³Wenying Xia^1,2Fang Ni^1,2Yiling Huang^1,2*Jue Wang^1,2*

• ¹Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
• ²National Key Clinical Department of Laboratory Medicine, Nanjing, China
• ³Department of Clinical Laboratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China

Background: In response to the increasing incidence of candidemia, this study aimed to investigate its epidemiology and determine in-hospital mortality risk factors in an eastern Chinese tertiary hospital, thereby guiding clinical management. Methods: This retrospective study enrolled 387 inpatients with candidemia at the First Affiliated Hospital of Nanjing Medical University from 2015 to 2024. Species distribution, demographic and clinical characteristics, antifungal treatment data were analyzed, and their impact on in-hospital mortality were assessed using univariate and multivariate logistic regression. Results: The average 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 source of cases (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%). Notably, one isolate of Candida auris (0.26%) was identified. Candidemia in adolescents was dominated by the C. parapsilosis complex (42.86%). 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%). The vast majority of C. albicans and C. parapsilosis were susceptible (> 90%) to all nine antifungal agents; while C. tropicalis exhibited relatively high resistance/non-wild-type (18.06%-69.44%) to four azoles with a 27.78% cross-resistance rate to fluconazole and voriconazole. Multivariate analysis revealed that age ≥63 years (OR=1.726, 95% CI: 1.049-2.840, P=0.032), ICU admission (OR=2.315, 95% CI: 1.256-4.266, P=0.007), acute or chronic renal failure (OR=2.287, 95% CI: 1.298-4.031, P=0.004), and mechanical ventilation (OR=1.887, 95% CI: 1.037-3.433, P=0.038) significantly increased the risk of in-hospital mortality (all identified as independent risk factors), whereas C. parapsilosis complex infection (OR=0.400, 95% CI: 0.212-0.755, P=0.005) was independently associated with a significantly decreased risk. Conclusions: C. albicans was the predominant cause of candidemia in our institute. Given the high incidence and mortality rates, it was imperative to develop tailored management and prevention strategies based on the local pathogen profile, antifungal susceptibility patterns, and specific mortality risk factors. Particular attention should focus on high-risk patients to ultimately improve clinical outcomes.