Prevalence, Clinical Distribution, and Antifungal Resistance Patterns of Candida Species Isolated from Patients at Parirenyatwa Group of Hospitals from 2023 to 2025

Abstract

Candida infections are increasingly recognized as a major public health concern, particularly in immunocompromised patients such as those undergoing chemotherapy, living with HIV, or experiencing vaginal and gestational health complications. At Parirenyatwa Group of Hospitals, the absence of routine species-level identification and antifungal susceptibility testing (AST) poses a significant challenge to effective treatment. This study aimed to determine the local prevalence, species distribution, and antifungal resistance patterns of Candida isolates. A combined retrospective (January 2023–July 2025) and prospective (April 2025–October 2025) study was conducted, analyzing 271 patient samples. Of these, 91 (33.6%) were Candida positive. Candida albicans accounted for 56.0% (n=51), while non albicans Candida (NAC) species made up 44.0% (n=40). The majority of isolates were obtained from patients with urinary tract infections (14.3%), those attending antenatal care (13.2%), and patients undergoing chemotherapy (12.1%). Prospective antifungal susceptibility testing, which is not routinely performed at Parirenyatwa, was conducted on 20 isolates using the EUCAST Kirby-Bauer disc diffusion method. Alarmingly high resistance to fluconazole was observed, with 90.0% (n=18/20) of isolates being resistant. Resistance was high in both C. albicans (63.6%) and NAC species (88.9%). Although females (n=49) had slightly more infections than males (n=42), statistical analysis (p=0.9955) showed no significant gender based difference. The predominance of NAC species and the near-total resistance to fluconazole indicate that empirical fluconazole therapy is unreliable and likely to fail in this setting. These findings emphasize the urgent need for routine Candida species identification and antifungal susceptibility testing to guide appropriate therapy and inform updates to local treatment guidelines. Additionally, strengthened infection prevention and control measures are crucial to limit the spread of drug-resistant Candida infections and improve patient outcomes.