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Changing trends in incidence and antifungal susceptibility patterns of six  Candida  species causing candidemia in Kuwait between 2006–2017 are reported. A total of 2075 isolates obtained from 1448 patients were analyzed. Identity of  Candida  species isolates was determined by phenotypic methods and confirmed by PCR amplification/PCR-sequencing of rDNA and/or MALDI-TOF MS. Antifungal susceptibility was determined by Etest.  C .  albicans  accounted for 539 (37.22%) cases followed by  C .  parapsilosis  (n = 502, 34.67%),  C .  tropicalis  (n = 210, 14.5%),  C .  glabrata  (n = 148, 10.22%),  C .  krusei  (n = 27, 1.81%) and  C .  dubliniensis  (n = 22, 1.5%). The comparative percent distribution of  Candida  species causing candidemia between 2006–2011 and 2012–2017 was as follows:  C .  albicans  41.8% and 33.1%,  C .  parapsilosis  complex 32.01% and 37.04%,  C .  tropicalis  13.59% and 15.31%, and  C .  glabrata  8.77% and 11.51%,  C .  krusei  2.0% and 1.7%, and  C .  dubliniensis  1.75 and 1.3%, respectively. Three of 371  C .  albicans  isolates during 2006–2011 and five of 363 during 2012–2017 were resistant to fluconazole. Among  C .  parapsilosis  isolates, one of 310 during 2006–2011 and 21 of 446 during 2012–2017 were resistant to this drug. Furthermore, at an epidemiologic cutoff value (ECV) of ≤0.5 μg/ml, 70.1%  C .  albicans  isolates were wild-type for fluconazole during 2006–2011 as compared to 58.1% during 2012–2017. Likewise, at an ECV of ≤2 μg/ml, 98.0% of  C .  parapsilosis  isolates were wild-type during 2006–2011 as compared to 93.4% during 2012–2017. Clonal spread of fluconazole-resistant  C .  parapsilosis  in one major hospital was documented. An 8.8% shift in favor of non- albicans Candida  species with concomitant increase in MICs between the two periods preludes emergence of fluconazole-resistant candidemia cases in Kuwait.

Changing trends in epidemiology and antifungal susceptibility patterns of six bloodstream Candida species isolates over a 12-year period in Kuwait