Species distribution, antifungal susceptibility pattern and associated factors of Candida blood stream infections in Sri Lanka from 2018 to 2022

Introduction: Candidemia can be life-threatening in immunocompromised individuals thus, prompt diagnosis and treatment with antifungal agents is mandatory for successful outcome. Surveillance data on species distribution, antifungal susceptibility and associated factors of candidemia is utmost important to decide on empiric antifungal therapy, to impose infection control measures as well to promote antifungal stewardship in a country. Therefore, this study was aimed at retrospective review of data on candidemia at Mycology Reference Laboratory in Sri Lanka for 5 years duration to identify the species causing candidemia, their antifungal susceptibility pattern and associated factors. Results: A twofold rise in candidemia cases were seen during this 5-year duration compared to previous 7 years (2011-2017). Predominant species causing candidemia was C. tropicalis (35%) followed by C. parapsilosis (33%). C. albicans was the 3 rd commonest species causing candidemia in Sri Lanka. There were 3% C. glabrata cases, 2% C. guilliermondii and 1% C. famata and C. krusei cases. Importantly two sequencing confirmed C. auris cases were identified for the first time in Sri Lanka in 2021. Overall good antifungal susceptibility was seen for both fluconazole and amphotericin B and there were only 7% and 1.6% resistance respectively. Long term hospital stay (47%) was commonly seen in this study group followed by use of broad-spectrum antibiotics (24%) and involvement of gastro-intestinal tract (21%). Conclusion: Candida tropicalis is the commonest species causing candidemia in Sri Lanka. Common Candida species had good susceptibility to antifungals. Long term hospital stay was associated with candidemia in majority of patients.