AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO025370397
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ORIGINAL RESEARCH ARTICLE

Evaluation of species distribution, risk factors, and treatment modalities of Candida infections in the intensive care unit of a tertiary care center in Western Turkey

Yeliz Özdemir1* ,  Gamze Altan2 ,  Gülfem Ece3 ,  Hüseyin Özkarakaş4 ,  Selma Tosun5 ,  Zeki Tuncel Tekgül6
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1 Department of Infectious Disease and Clinical Microbiology, Izmir City Hospital, Izmir, Turkey
2 Department of Medical Microbiology, Bozyaka Education and Research Hospital, Izmir, Turkey
3 Department of Medical Microbiology, Izmir City Hospital, Izmir, Turkey
4 Department of Intensive Care Unit, University of Health Sciences Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
5 Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
6 Department of Anesthesiology and Reanimation, University of Health Sciences Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
EJMO, 025370397 https://doi.org/10.36922/EJMO025370397
Received: 14 September 2025 | Revised: 14 October 2025 | Accepted: 27 October 2025 | Published online: 18 November 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Candida species are increasingly recognized as significant nosocomial pathogens. In patients hospitalized in the intensive care units (ICUs), the risk of candidemia is particularly high due to the coexistence of multiple risk factors.

Objective: In this study, we investigated the distribution of Candida species, antifungal susceptibility, risk factors, and mortality in ICU patients with nosocomial Candida infections.

Methods: This retrospective study included 63 adult patients with candidemia hospitalized in the ICU between January 2021 and March 2023. Demographic, clinical, and laboratory data were analyzed. Statistical analysis was performed using the Chi-square test, Mann–Whitney U test, and logistic regression.

Results: Non-albicans Candida (NAC) species accounted for 61.9% of all isolates, with Candida parapsilosis (42.8%) being the most common. Gastrointestinal surgery significantly increased the risk of NAC infection (p=0.038). Higher serum albumin levels were associated with a reduced risk of mortality (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.77–0.97, p=0.013), and elevated urea levels were associated with an increased risk of mortality (OR: 1.023, 95% CI: 1.008–1.038, p=0.002). All of the 16 tested isolates were susceptible to anidulafungin, while 66.6% of C. parapsilosis isolates were resistant to fluconazole. The overall mortality rate was 66.7%.

Conclusions: NAC species should be considered in empirical treatment strategies, particularly for patients hospitalized in ICUs where this species is prevalent and for those with a history of gastrointestinal surgery. Low albumin and elevated urea may serve as potential predictors of mortality and should be carefully monitored. Echinocandins remain the most appropriate empirical agents given the high fluconazole resistance observed among C. parapsilosis isolates.

Keywords
Candida parapsilosis
Candidemia
Risk factors
Antifungal susceptibility
Funding
None.
Conflict of interest
The authors have no conflicts of interest to declare.
References
  1. Koehler P, Stecher M, Cornely OA, et al. Morbidity and mortality of Candidaemia in Europe: An epidemiologic meta-analysis. Clin Microbiol Infect. 2019;25(10):1200-1212. doi: 10.1016/j.cmi.2019.04.024

 

  1. Scaglione G, Colaneri M, Offer M, et al. Epidemiology and clinical insights of catheter-related candidemia in non- ICU patients with vascular access devices. Microorganisms. 2024;12(8):1597.doi: 10.3390/microorganisms12081597

 

  1. Asogan M, Kim HY, Kidd S, et al. Candida parapsilosis: A systematic review to inform the World Health Organization fungal priority pathogens list. Med Mycol. 2024;62(6):myad131. doi: 10.1093/mmy/myad131

 

  1. Pfaller MA, Messer SA, Moet GJ, Jones RN, Castanheira M. Candida bloodstream infections caused by C. glabrata and C. krusei: Antifungal resistance and patient outcomes in a global surveillance program. Antimicrob Agents Chemother. 2009;53(4):1629-1634.

 

  1. McCarty TP, White CM, Pappas PG. Candidemia and invasive candidiasis. Infect Dis Clin North Am. 2021;35(2):389-413. doi: 10.1016/j.idc.2021.03.007

 

  1. Bays DJ, Jenkins EN, Lyman M, et al. Epidemiology of invasive candidiasis. Clin Epidemiol. 2024;16:549-566. doi: 10.2147/CLEP.S459600

 

  1. Kocabaş D, Aydin NN, Aksoy F, et al. İki farklı yoğun bakım ünitesinde kandidemi için risk faktörlerinin değerlendirilmesi [Evaluation of risk factors for candidemia in two different intensive care units]. Kirikkale Univ Med J. 2021;23(3):429-436. [In Turkish].

 

  1. Kutlu M, Sayin-Kutlu S, Alp-Cavus S, et al. Mortality-associated factors of candidemia: A multi-center prospective cohort in Turkey. Eur J Clin Microbiol Infect Dis. 2022;41(5):597-607. doi: 10.1007/s10096-021-04394-0

 

  1. Aydin S, Derin O, Sahin M, et al. Epidemiology of nosocomial candidemia, mortality, and antifungal resistance: 7-year experience in Turkey. Jpn J Infect Dis. 2022;75(6):597-603. doi: 10.7883/yoken.JJID.2022.181

 

  1. Puig-Asensio M, Padilla B, Garnacho-Montero J, et al. Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: A population-based surveillance in Spain. Clin Microbiol Infect. 2014;20(3):O245-O254. doi: 10.1111/1469-0691.12380

 

  1. Clinical and Laboratory Standards Institute (CLSI). Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts; Approved Standard. 3rd ed. CLSI document M27-A3. Wayne, PA: Clinical and Laboratory Standards Institute; 2008.

 

  1. Pfaller MA, Rex JH, Rinaldi MG. Antifungal susceptibility testing: Technical advances and potential clinical applications. Clin Infect Dis. 1997;24(5):776-784. doi: 10.1093/clinids/24.5.776

 

  1. Clinical and Laboratory Standards Institute (CLSI). Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts. 4th ed. CLSI document M27-S4. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.

 

  1. Vannini M, Emery S, Lieutier-Colas F, et al. Epidemiology of candidemia in NICE area, France: A five-year study of antifungal susceptibility and mortality. J Mycol Med. 2022;32(1):101210. doi: 10.1016/j.mycmed.2021.101210

 

  1. Zhang C, Wu S, Chen X. Analysis of the Clinical Characteristics and Treatment of Candidemia caused by Different Pathogens. Preprint. Research Square; 2021. Available from: https://www.researchsquare.com/article/ rs-4482254/v1 [Last accessed 2025 Nov 14].

 

  1. Kerget F, Karasahin O, Celik N, et al. Evaluation of Candida species and candidemia risk factors isolated from patient samples in the intensive care unit. Bozok Med J. 2020;10(1):55-61.

 

  1. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: A persistent public health problem. Clin Microbiol Rev. 2007;20(1):133-163. doi: 10.1128/CMR.00029-06

 

  1. Toda M, Williams SR, Berkow EL, et al. Population-based active surveillance for culture-confirmed candidemia-four sites, United States, 2012-2016. MMWR Surveill Summ. 2019;68(41):1-15. doi: 10.15585/mmwr.mm6841a2

 

  1. Chow JK, Golan Y, Ruthazer R, et al. Factors associated with candidemia caused by non-albicans Candida species versus Candida albicans in the intensive care unit. Clin Infect Dis. 2008;46(8):1206-1213. doi: 10.1086/529435

 

  1. Dimopoulos G, Ntziora F, Rachiotis G, Armaganidis A, Falagas ME. Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: Differences in risk factors and outcome. Anesth Analg. 2008;106(2):523-529. doi: 10.1213/ane.0b013e3181607262

 

  1. Playford EG, Marriott D, Nguyen Q, et al. Candidemia in nonneutropenic critically ill patients: risk factors for non-albicans Candida species. Crit Care Med. 2008;36(7):2034-2039. doi: 10.1097/CCM.0b013e3181760f42

 

  1. Livermore DM. Minimising antibiotic resistance. Lancet Infect Dis. 2005;5(7):450-459. doi: 10.1016/S1473-3099(05)70166-3

 

  1. Hadano Y, Suyama A, Miura A, et al. Impact of the antimicrobial stewardship program on hospital-acquired candidemia. Sci Rep. 2022;12(1):15135. doi: 10.1038/s41598-022-19374-3

 

  1. Lin MY, Carmeli Y, Zumsteg J, et al. Prior antimicrobial therapy and risk for hospital-acquired Candida glabrata and Candida krusei fungemia: A case-case-control study. Antimicrob Agents Chemother. 2005;49(11):4555-4560. doi: 10.1128/AAC.49.11.4555-60.2005

 

  1. Kapmaz M. Investigation of the Effects of Commonly Used Ceftriaxone, Piperacillin-Tazobactam, and Imipenem- Silastatin on Candida Colonization: A Prospective Study [Master’s Thesis]. Istanbul, Turkey: Istanbul University; 2011.

 

  1. Mavromanolakis E, Maraki S, Cranidis A, Tselentis Y, Kontoyiannis DP, Samonis G. The impact of norfloxacin, ciprofloxacin, and ofloxacin on human gut colonization by Candida albicans. Scand J Infect Dis. 2001;33(6):477-478. doi: 10.1080/00365540152030006

 

  1. Samonis G, Kofteridis DP, Maraki S, et al. Levofloxacin and moxifloxacin increase human gut colonization by Candida species. Antimicrob Agents Chemother. 2005;49(12):5189. doi: 10.1128/AAC.49.12.5189.2005

 

  1. Heung LJ. Monocytes and the host response to fungal pathogens. Front Cell Infect Microbiol. 2020;10:34. doi: 10.3389/fcimb.2020.00034

 

  1. Thompson A, Davies LC, Liao CT, et al. The protective effect of inflammatory monocytes during systemic Candida albicans infection is dependent on collaboration between C-type lectin-like receptors. PLoS Pathog. 2019;15(7):e1007850. doi: 10.1371/journal.ppat.1007850

 

  1. Noble SM, Gianetti BA, Witchley JN. Candida albicans cell-type switching and functional plasticity in the mammalian host. Nat Rev Microbiol. 2017;15(2):96-108. doi: 10.1038/nrmicro.2016.157

 

  1. Tukenmez Tigen E, Bilgin H, Perk Gurun H, et al. Risk factors, characteristics, and outcomes of candidemia in an adult intensive care unit in Turkey. Am J Infect Control. 2017;45(6):e61-e63. doi: 10.1016/j.ajic.2017.02.022

 

  1. Muderris T, Kaya S, Ormen B, et al. Mortality and risk factor analysis for Candida blood stream infection: A three-year retrospective study. J Mycol Méd. 2020;30(4):101008. doi: 10.1016/j.mycmed.2020.101008

 

  1. Battistolo J, Glampedakis E, Damonti L, et al. Increasing morbidity and mortality of candidemia over one decade in a Swiss university hospital. Mycoses. 2021;64(12):1512-1520. doi: 10.1111/myc.13376

 

  1. Kir S, Bahceci BK. Evaluation of the prognostic factors for candidemia in a medical intensive care unit. J Surg Med. 2020;4(10):870-874.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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