Sterile-site yeast isolates linked to fungemia, sepsis, and mortality in a retrospective cohort study.

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Frontiers in Medicine Published April 22, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note that sterile-site yeast isolates independently predict fungemia, sepsis, and mortality in this retrospective cohort.

This retrospective cohort study evaluated 231 consecutive sterile-site yeast isolates obtained from patients at Nanjing Drum Tower Hospital between 2019 and 2023. The analysis focused on associations between isolate characteristics and clinical outcomes including fungemia, sepsis, and in-hospital mortality. Multivariable logistic regression was used to identify independent predictors while acknowledging that contemporary links between species ecology, antifungal susceptibility, and patient outcomes remain underdefined.

Sepsis occurred in 23.8% of cases and was independently associated with ICU admission, with an odds ratio of 7.119 (95% CI 2.811–18.026). Conversely, surgery showed a protective association with an odds ratio of 0.426 (95% CI 0.190–0.954). Fungemia was independently associated with blood transfusion and hemodialysis catheterization, where surgery demonstrated a protective effect with an odds ratio of 0.320 (95% CI 0.171–0.599). Overall mortality was observed in 26.8% of the cohort, and acute kidney injury was associated with an increased risk of mortality (OR 3.354, 95% CI 1.563–7.198).

No specific adverse events, serious adverse events, discontinuations, or tolerability data were reported in the study. The authors note that independent predictors were identified via multivariable logistic regression. Given the retrospective nature of the study, these associations should be interpreted cautiously rather than as definitive causal relationships. The practice relevance supports prompt device removal, restrictive transfusion, proactive renal management, and echinocandin-first strategies in high-risk patients.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundYeast infections from sterile body fluids are increasingly encountered in tertiary care, yet contemporary links between species ecology, antifungal susceptibility, and patient outcomes remain underdefined.MethodsWe conducted a retrospective cohort study of 231 consecutive sterile-site yeast isolates at Nanjing Drum Tower Hospital (2019–2023). Species were identified by CHROMagar and MALDI-TOF MS; antifungal MICs were determined using YeastOne and interpreted by CLSI M27-Ed3. Clinical data were abstracted from electronic records. Variables with p < 0.10 in univariate testing entered multivariable logistic regression to identify independent predictors of fungemia, sepsis, and in-hospital mortality.ResultsThe four major Candida species showed distinct susceptibility profiles, with C. albicans broadly susceptible, C. tropicalis exhibiting notable azole resistance, Nakaseomyces glabratus (C. glabrata) displaying high azole MICs but good echinocandin activity, and C. parapsilosis maintaining low azole MICs but intrinsically higher echinocandin MICs. Clinically, bloodstream involvement was frequent. Fungemia was independently associated with blood transfusion and hemodialysis catheterization, whereas surgery was protective (OR 0.320, 95% CI 0.171–0.599). Sepsis occurred in 23.8% and was independently associated with ICU admission (OR 7.119, 95% CI 2.811–18.026); surgical treatment again showed a protective association (OR 0.426, 95% CI 0.190–0.954). Overall mortality was 26.8%; acute kidney injury (AKI) independently predicted death (OR 3.354, 95% CI 1.563–7.198).ConclusionsIn this five-year cohort, Candida—led by C. albicans with a rising non-albicans share—dominated sterile-site infections. Echinocandins and amphotericin B retained broad activity, whereas azole activity was reduced in C. tropicalis/N. glabratus. Across outcomes, transfusion and hemodialysis catheters increased fungemia risk, ICU admission increased sepsis risk, AKI drove mortality, and early surgical source control was consistently protective. These findings support prompt device removal, restrictive transfusion, proactive renal management, and echinocandin-first strategies in high-risk patients.