Candidemia in a General Hospital in Kuwait: Epidemiology, Species Distribution, Risk Factors, and Antifungal Susceptibility Patterns over a 10-Year Period (2015-2024).

Abstract

This 10-year retrospective observational study (2015-2024) conducted at Al-Amiri Hospital in Kuwait aimed to analyze the epidemiology, species distribution, and key risk factors associated with Candida bloodstream infections. Data were collected on patient demographics and clinical risk factors, and the distribution of Candida species was determined based on isolates recovered from patients with confirmed candidemia. Multivariate logistic regression was performed to identify factors associated with candidemia outcomes. Cases significantly increased from 33 (2015-2016) to 93 (2023-2024), predominantly affecting elderly patients (≥65 years) and intensive care unit (ICU) admissions. A shift in species distribution was observed, with a decline in Candida albicans and a marked increase in Candidozyma auris (formerly Candida auris) and C. parapsilosis. Antifungal susceptibility patterns were species-specific: C. albicans, C. parapsilosis, and C. tropicalis remained highly susceptible to all tested antifungals, while Nakaseomyces glabratus (formerly Candida glabrata) showed fluconazole resistance in 25% of isolates. C. auris exhibited resistance to fluconazole (97%) and variable resistance to echinocandins and voriconazole. Echinocandins retained broad-spectrum activity across most species. Independent risk factors included ICU admission, advanced age, and comorbidities. N. glabratus and C. auris infections were linked to higher mortality. This study highlights the growing candidemia burden in Kuwait, driven by emerging non-albicans Candida (NAC) spp. and related species. Early species identification and susceptibility testing are crucial for effective treatment and improved outcomes, necessitating enhanced infection control and antifungal stewardship.