BACKGROUND: Candidemia is a major global health concern with rising incidence and mortality. Regional surveillance is essential, as species distribution and antifungal resistance vary significantly. METHODS: We analyzed 541 Candida isolates from blood cultures at Cerrahpaşa Medical Faculty Hospital (2015–2023). Identification was performed using phenotypic methods, API 20 C AUX, BD Phoenix YEAST ID, and MALDI-TOF MS. Antifungal susceptibility was tested by gradient test (E-test) on RPMI agar, interpreted according to EUCAST guidelines for azoles, echinocandins, and amphotericin B. RESULTS: The most frequent isolates were C. albicans (n = 214, 39%; susceptibility tested in 150), C. parapsilosis (n = 164, 29%), C. glabrata (n = 47, 7%), C. tropicalis (n = 42, 7%), and C. krusei (n = 10, 2%). Other species accounted for 16% (n = 64), including cryptic species such as C. auris (n = 9) and C. haemulonii (n = 1). The total cases were 269 in the pre-COVID period and 272 in the COVID and post period, chi-square analysis indicated these differences were not statistically significant (χ²=7.43, df = 6, p = 0.283). Increased MIC values against azoles were significantly detected in C. glabrata isolates, while C. parapsilosis complex generally exhibited a relatively high MIC distribution and a decreased susceptibility pattern. C. krusei demonstrated intrinsic resistance to fluconazole but remained susceptible to voriconazole. CONCLUSIONS: Our findings demonstrate a shift, though not statistically significant, toward non-albicans Candida species with emerging azole resistance, including the detection of multidrug-resistant C. auris. These trends underscore the need for enhanced local surveillance, molecular diagnostics, and evidence-based antifungal stewardship to optimize patient outcomes. CLINICAL TRIAL NUMBER: Not applicable.
Keywords: Candida albicans; Azole; C. auris; Fluconazole; MALDI-TOF MS; Minimum inhibitory concentration; Non-albicans Candida.