Distribution and prevalence of fungemia: a five-year retrospective multicentric survey in Venetian region, Italy

Background: Invasive fungal infections, significantly impact hospitalized and immunocompromised populations. Recent trends showed a shift from Candida albicans to non-albicans Candida (NAC) species, raising concerns about antifungal resistance. Objectives: Our study focuses on the distribution of fungal species in blood cultures obtained from different healthcare settings, including hospitals, long-term care facilities, and community health centers in the Venetian region of Italy. Methods: We retrospectively analyzed all consecutive blood culture isolates across 5 hospitals, 38 long-term care facilities, and 24 sample collection centers (blood exams and culture) from 2019 to 2023. Results: Between 2019 and 2023, 11,552 microorganisms were isolated from blood cultures; 693 (6.0%) were fungi. The yearly prevalence ranged from 5.2% in 2019 to 6.1% in 2023. C. albicans isolates decreased significantly, from 60.0% in 2019 to 43.1% in 2023. NAC species showed significant growth, particularly C. parapsilosis sensu stricto (from 23.6% in 2019 to 28.8% in 2023), C. tropicalis (from 0.0% in 2019 to 7.2% in 2023), and N. glabratus (from 9.1% in 2019 to 11.8% in 2023). Medical wards consistently recorded the highest number of cases (429/693, 61.9%), with C. albicans predominating in earlier years. Resistance to amphotericin B rose sharply in C. parapsilosis ss. (22.5% in 2022), while fluconazole resistance in N. glabratus remained high (peaking at 85.7% in 2021). Conclusion: The increasing dominance of NAC species and rising resistance trends underscore the necessity for enhanced diagnostics, infection prevention, and antifungal stewardship. Future research should incorporate clinical data to optimize fungemia management strategies.