Epidemiology, Antifungal Therapy, and Outcomes of Invasive Candidiasis Across Six Mexican Tertiary Care Hospitals (2021-2024)
Luis Asdruval Zepeda-Gutiérrez, Jaime Briseno-Ramirez, Mauricio Alfredo Ambriz-Alarcón, Edson Alberto Rea-Márquez, Enrique Cervantes-Pérez, Patricia Cornejo-Juárez, Ariadna Barajas-Silva, María Fernanda González-Lara, Ever Arturo Corral-Herrera, Rosa Areli Martínez-Gamboa, Adrián Camacho-Ortiz, Jimena Flores-Garza, Luis Oliverio Ambriz-García, Sharon Michelle Conejo-Angeles, José Raúl Padilla-Gutiérrez, Erick Alejandro Nevárez-Reza, Pedro Martínez-AyalaAbstract
Background
Invasive candidiasis (IC) is a leading cause of nosocomial mortality; multicenter Latin American data are scarce. We characterized IC epidemiology, management, and outcomes at six Mexican tertiary hospitals and applied a Bayesian hierarchical Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to estimate per-center empiric coverage.
Methods
Retrospective cohort of 574 consecutive IC episodes (January 2021 – December 2024) across four Mexican states. Thirty-day all-cause mortality was the primary outcome. Mixed-effects logistic regression with hospital random intercept identified predictors; propensity-based and adjusted temporal-trend analyses tested robustness. A Bayesian hierarchical WISCA estimated empiric-regimen coverage.
Results
Non-albicans species accounted for 64.5% of isolates (N. glabratus 22.8%, C. tropicalis 18.8%, C. parapsilosis 17.2%); Candidozyma auris was not detected. Thirty-day mortality was 36.6% (candidemia 39.5%, similar to a contemporary European cohort); the crude decline from 43.9% in 2021 to 27.4% in 2024 attenuated after adjustment (aOR/year 0.86; 95% CI 0.69–1.09). Septic shock (aOR 8.35) and mechanical ventilation (aOR 2.03) independently predicted mortality; empiric antifungal therapy was associated with lower mortality odds (aOR 0.45). WISCA fluconazole coverage was 78.8% overall (95% HDI 75.5–81.7), below the 80% operational threshold at three of four analytic centers; micafungin exceeded 97% at every center (overall 98.3%, 95% HDI 97.0–99.3).
Conclusions
Thirty-day IC mortality remains substantial; its crude decline was not independent of case mix and center. Empiric antifungal therapy was associated with lower mortality. In vitro coverage was below threshold for fluconazole at most centers and uniformly high for micafungin, without establishing clinical effectiveness. Non-culture diagnostics remain a priority gap.