Investigating the Increasing Azole Resistance in Candida Infections Among Critically Ill Patients - Experience From a Tertiary-Level Setup in North India

Sep 28, 2026

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Candida infections in critically ill patients are shifting toward non-albicans species, alongside rising resistance to widely used azole antifungals. This study identified Candida species spectra from routine clinical cultures and determined antifungal sensitivity patterns using CLSI guidance over April 2023 to March 2025. Among 382 samples, blood predominated, with fluconazole and voriconazole resistance highest in blood isolates. Azole resistance increased over time, while echinocandin resistance remained low. Findings support continued regional surveillance and antifungal stewardship to reduce public health impact.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

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Abstract

Introduction

Objectives

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Review began 11/12/2025 Review ended 11/25/2025 Published 12/03/2025 © Copyright 2025 Singh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98425 Open Access Original Article Investigating the Increasing Azole Resistance in Candida Infections Among Critically Ill Patients: Experience From a Tertiary-Level Setup in North India Sweta Singh 1, Sana Islahi 2 , Kalicharan Das 3, Shefali Gupta 2 1. Clinical Microbiology, All India Institute of Medical Sciences, Raebareli, IND 2. Microbiology, All India Institute of Medical Sciences, Raebareli, IND 3. Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, IND Corresponding author: Sweta Singh, [swetasinghkarn@gmail.com](swetasinghkarn@gmail.com) Abstract Introduction: Candida species are among the most common fungal pathogens worldwide, with varied clinical presentations and manifestations in both immunocompetent and compromised individuals. In recent years, both global and Indian research have documented a progressive shift from Candida albicans to treatmentresistant non-albicans Candida (NAC) spp. Compared with Western countries, there is a dearth of information on invasive Candida infections in India. The azole group of drugs is most widely used for Candida infections, and this is the reason for the increasing resistance reported in this class of drugs. Recently, resistance to azoles has increased in Candida species, both in clinical settings and in vitro. Objectives: The present study aims to identify the spectrum of Candida species in clinical infections and to identify their sensitivity pattern to available antifungal agents. Methods: The study was conducted over 24 months, from April 2023 to March 2025, on clinical samples received for routine culture and sensitivity testing. Antifungal sensitivity was tested according to the Clinical and Laboratory Standards Institute guidelines and interpreted. Demographic and other patient parameters were also assessed. Statistical analysis: The results were analyzed using the Statistical Package for the Social Sciences version 22 software (SPSS Inc., Chicago, IL) . Results: The total number of samples analyzed for fungal etiology during the specified time period was 382, of which 57.5%(n = 219) were contributed by blood, 29.2%(n = 112) by urine samples, and the remaining 13.3%(n = 51) by intra-abdominal samples, tissue, pus, and body fluids. Individually, C. albicans was higher in blood samples than in urine samples (43 .5% vs. 41. 7%). The overall resistance rates in blood isolates to fluconazole and voriconazole were reported as 21.4% and 5 .6%, respectively. The trend of Azole resistance from 2023 to 2025 increased for fluconazole from 18.5% to 34.6% and for voriconazole from 5. 7% to 10.2% . Echinocandin resistance, however, was not notable, ranging from 0.6% in 2023 to 1.6% in 2025. Conclusion: Our study emphasizes the role of increased Candida isolates and resistance trends across various samples over the specified time period. C. albicans was the most commonly isolated Candida species overall, but the gradual shift of Candida species to non-albicans species (NAC) is very much pertinent in our study. Candida auris remains undetected in blood and other invasive samples in the present study. Our study did not report any C. auris isolate. This may be due to the constant and strong reinforcement of enhanced infection control measures, including environmental decontamination and contact precautions. The present study showed a significant increase in antifungal susceptibility testing volumes over the study period, reflecting the growing clinical burden of Candida species. The potential rise in the azole group of drug resistance emphasizes the ne

FAQs

What was the study’s main objective?

To identify the spectrum of Candida species in clinical infections and determine their sensitivity patterns to available antifungal agents.

What timeframe and data sources were used?

Clinical samples were collected over 24 months, from April 2023 to March 2025, from routine culture and sensitivity testing.

How did azole resistance change from 2023 to 2025?

Resistance increased over time: fluconazole rose from 18.5% to 34.6% and voriconazole from 5.7% to 10.2%.

What do the authors recommend based on the findings?

Strengthen continued regional surveillance, antifungal stewardship programs, and infection control measures to mitigate antifungal resistance and improve clinical outcomes.

Sep 28, 2026

Uploaded by Riley