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This study provide an up-to-date overview of the epidemiology and risk factors for  Candida  bloodstream infection in Scotland in 2012/2013, and the antifungal susceptibility of isolates from blood cultures from 11 National Health Service boards within Scotland.  Candida  isolates were identified by chromogenic agar and confirmed by MALDI–TOF methods. Survival and associated risk factors for patients stratified as  albicans  and non- albicans  cases were assessed. Information on the spectrum of antifungals used was collected and summarized. The isolates sensitivity to different antifungals was tested by broth microdilution method and interpreted according to CLSI/EUCAST guidelines. Forty one percent of candidaemia cases were associated with  Candida albicans , followed by  C. glabrata  (35%),  C. parapsilosis  (11.5%), and remainder with other  Candida  spp.  C. albicans  and C.  glabrata  infections were associated with 20.9 and 16.3% mortality, respectively. Survival of patients with  C. albicans  was significantly lower compared to non- C. albicans  and catheter line removal in  C. albicans  patients significantly increases the survival days. Predisposing factors such as total parenteral nutrition, and number of days on mechanical ventilation or in intensive care, were significantly associated with  C. albicans  infections. Fluconazole was used extensively (64.5%) for treating candidaemia cases followed by echinocandins (33.8%). Based on CLSI breakpoints, MIC test found no resistance to any antifungals tested except 5.26% fluconazole resistance among  C. glabrata  isolates. Moreover, by comparing to EUCAST breakpoints we found 3.95% of  C. glabrata  isolates were resistant to anidulafungin. We have observed a shift in  Candida  spp. with an increasing isolation of  C. glabrata . Delay and choice of antifungal treatment are associated with poor clinical outcomes.

A Prospective Surveillance Study of Candidaemia: Epidemiology, Risk Factors, Antifungal Treatment and Outcome in Hospitalized Patients