Comprehensive Analysis of Candida Species Distribution, Virulence Determinants, and Clinical Significance in Hospitalized Patients: An Extended Review and Descriptive Study

Abstract

Background: Candida species have become notable opportunistic pathogens, causing infections that range from surface-level involvement to severe invasive disease within healthcare environments. Variations in species distribution, virulence traits, and antifungal susceptibility complicate management.

Aim and Objective: To provide an elongated narrative review supported by recent evidence and bring together the outcomes from a descriptive analysis that examines species prevalence and virulence characteristics in Candida isolates obtained from diverse clinical samples of hospitalized patients.

Material and Methods: A consolidated review of published literature (2015–2025) and institutional descriptive data was performed. Clinical samples included urine, blood, respiratory specimens, wound swabs, high vaginal swabs, and catheter tips. A narrative review was conducted using PubMed, Scopus, Google Scholar, and Embase databases. Studies published between 2015 and 2025 evaluating Virulence markers assessed included germ tube formation, phospholipase activity, proteinase activity, and biofilm formation. Isolation and identification were done using CHROMagar, sugar assimilation tests, and standard mycological methods.

Results: The descriptive study showed Candida albicans as the most frequent species (≈45–50%), followed by C. tropicalis (≈25–30%), C. glabrata (≈10–15%), and C. parapsilosis (≈5–8%). High virulence expression was noted in C. albicans (germ tube-positive in >90%, biofilm in >80%), while non-albicans Candida species (NAC) exhibited stronger biofilm and proteinase activity. Literature comparison showed increasing NAC predominance in recent years.

Conclusion: Candida infections remain clinically important in hospitalized patients. The rising trend of NAC species with heightened virulence and antifungal resistance necessitates early identification and species-level diagnosis.