597 INTRODUCTION Candidemia is an important clinical condition that prolongs hospitalization and increases morbidity, mortality, and hospital costs. In the 1980s, candidemia spread rapidly, with Candida albicans being the most common pathogen. However, in the late 1990s, the prevalence of other Candida species (spp.) began to increase. Moreover, sensitivity to antifungal agents has changed in parallel with changes in the distribution of Candida spp. in candidemia cases, and resistance of Candida spp. to triazole and echinocandins is increasing rapidly (1,2). Several risk factors for candidemia cases have been identified, including severe neutropenia, solid- organ transplantation, hematological and solid-organ malignancies, steroid use, cytotoxic drug use, prolonged antibiotic use, intensive care unit (ICU) admission, and invasive interventions (3,4). Between January 2013 and December 2019, we conducted a retrospective cross-sectional study to evaluate the epidemiological and microbiological development of candidemia in patients over a seven- year period. MATERIALS AND METHODS Institution: This study was conducted in a tertiary care hospital in Turkey with a bed capacity of 800 beds, 600 of which are actively used in the Istanbul Medipol University Medical Faculty Hospital, a tertiary care hospital where solid-organ and hematopoietic stem cell transplantation is performed and all intensive care units have 90 beds. The study enrolled adult patients who had spent more than 48 h in the hospital between 2013 and 2019 and subsequently developed candidemia. Patient Original Article Epidemiology of Nosocomial Candidemia, Mortality, and Antifungal Resistance: 7-Year Experience in Turkey Selda Aydin 1 * , Okan Derin 2 , Meyha Sahin 1 , Rumeysa Dinleyici 3 , Mesut Yilmaz 1 , Bahadır Ceylan 1 , Ayse Istanbullu Tosun 4 , Recep Ozturk 1 , and Ali Mert 5 1 Department of Infectious Diseases and Clinical Microbiology, 4 Department of Medical Microbiology, and 5 Department of Internal Medicine, School of Medicine, and 3 Department of Clinical Pharmacy, School of Pharmacy, Istanbul Medipol University, Istanbul; and 2 Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey ABSTRACT: Candidemia is an important clinical condition that prolongs hospital stays and increases morbidity, mortality, and hospital costs. The aim of this retrospective study was to evaluate the epidemiological and microbiological characteristics of patients with candidemia between January 2013 and December 2019. Two hundred forty-one episodes of candidemia were observed in 230 patients, 45% of whom were female. The median age was 63 years, and 53.9% of the episodes were in the intensive care unit (ICU). Commonly observed predisposing factors for candidemia included antibiotic use (71.3%), urinary catheterization (56.3%), central venous catheter placement (50.3%), total parenteral nutrition (47.9%), solid-organ malignancy (46%), surgery (48.6%), chemotherapy (37%), and steroid treatment (25.5%). The crude mortality rate was 52.7%. A signifcant diference was found between survivors and non-survivors (P = 0.007) according to the Charlson Comorbidity Index. However, no statistically significant association was found between mortality and age, sex, surgical procedure, catheter-related candidemia, or Candida spp. infection. The most frequently isolated Candida sp. was C. albicans (51%). Overall resistance rates to fuconazole, voriconazole, caspofungin, micafungin, and flucytosine were 3.7%, 0%, 2.5%, 1.8%, and 1.8%, respectively. Consequently, there is a need for tests that provide higher success rates, rapid diagnosis of candidemia, and local epidemiological data on antifungal resistance. Received April 1, 2022. Accepted July 7, 2022. J-STAGE Advance Publication July 29, 2022. DOI: 10.7883/yoken.JJID.2022.181 *Corresponding author: Mailing address: Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol University, Istanbul 34000, Turkey. Tel: +905322032754, Fax: +902124607070, E-mail: seldaaydin@medipol.edu.tr Jpn. J. Infect. Dis., 75, 597-603, 2022