Trends in Antifungal Resistance Among Candida Species: An Eight-Year Retrospective Study in the Galveston-Houston Gulf Coast Region.

Abstract

Fungal systemic infections are a growing global health concern, particularly among immunocompromised individuals. Candida species are the leading cause of invasive fungal infections, with C. albicans historically being the most prevalent. The emergence of C. auris, known for its multidrug resistance, presents additional challenges for treatment and infection control. This study retrospectively analyzed minimal inhibitory concentration (MIC) data for common Candida species isolated from patients in the Galveston-Houston Gulf Coast region from the EPIC Laboratory Information System (LIS) between October 2016 and September 2024. Antifungal susceptibility was assessed using the Sensititre^TM YeastOne^TM YO9 AST Plate and interpreted per Clinical and Laboratory Standard Institute (CLSI) guidelines. A total of 1206 clinical yeast isolates from over 29 species were identified, with Candida species accounting for 94.5% (1140). C. albicans (30.7%), C. glabrata (23.5%), C. parapsilosis (12.2%), and C. tropicalis (10.4%) were the most prevalent. C. auris (6.2%) emerged in late 2021 in our region, showing high MICs against fluconazole (92%) and amphotericin B (32.2%). While C. albicans, C. parapsilosis, and C. tropicalis remained susceptible to echinocandins, fluconazole resistance showed an increasing trend. C. glabrata exhibited variable susceptibility to both echinocandins and azoles. These findings highlight the urgent need for enhanced antifungal stewardship, improved diagnostics, and novel therapeutic strategies. Continued regional surveillance and targeted interventions are essential to mitigating the impact of antifungal resistance.