EC Neurology

Background: Candidaemia is one of the most frequent invasive fungal infections in hospitals and carries high mortality. Published epidemiological data from Morocco remain fragmentary, which limits the transposition of Western models to our setting. This study aimed to describe the epidemiological and mycological profile of candidaemia diagnosed at Ibn Sina University Hospital, Rabat.

Materials and Methods: A single-centre retrospective descriptive study was conducted in the Central Laboratory of Parasitology-Mycology of Ibn Sina University Hospital, Rabat, over 27 years, from January 1997 to December 2023. All patients, irrespective of age or ward, with at least one blood culture positive for a yeast of the genus Candida were included. Identification relied on culture on Sabouraud media and on API Candida or API 20C AUX strips (bioMérieux, Marcy-l’Étoile, France). Antifungal susceptibility was assessed with the FUNGITEST method (Bio-Rad, Marnes-la-Coquette, France).

Results: Among 1,724 requests for mycological blood culture, 53 episodes of candidaemia were identified, giving an overall positivity rate of 3.1%. The cohort comprised 28 women and 25 men (male-to-female sex ratio 0.89), with a mean age of 39.5 years, including five neonates (9.4%). Medical intensive care accounted for 54.7% of episodes, ahead of neonatology (9.4%) and cardiovascular surgery (7.5%). Among the 30 isolates identified to species level, Candida albicans remained the dominant species (43.3%), but non-albicans species were collectively predominant (56.7%), led by C. parapsilosis (23.3%) and C. tropicalis (16.7%), while C. glabrata remained a minority (10.0%).

Conclusion: The low number of requests and documented cases contrasted with the incidence expected in Morocco and with population-based incidences reported in Europe and the United States, arguing for major under-detection. The rank of C. parapsilosis and C. tropicalis, ahead of C. glabrata, brought our ecology closer to the southern European and Mediterranean pattern than to the North American one. This work documents the ecological shift towards non-albicans species and supports systematic species-level identification, standardised antifungal susceptibility testing according to EUCAST or CLSI, and sentinel surveillance integrated into an antifungal stewardship programme.

Keywords: Candidaemia; Non-Albicans Candida; Blood Culture; Invasive Fungal Infection; Epidemiology; Candida parapsilosis; Intensive Care; Morocco; Antifungal Resistance; Medical Mycology

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