Determinants of Antifungal Treatment Outcomes in Invasive Candidiasis Among Immunocompromised Patients in Kano, Kano State

Invasive candidiasis carries high mortality in immunocompromised patients, and treatment outcomes are shaped by a complex interplay of host factors, pathogen characteristics, and antifungal therapeutic variables. This study investigated the determinants of antifungal treatment outcomes in immunocompromised patients with confirmed invasive candidiasis at Aminu Kano Teaching Hospital (AKTH), Kano State, North West Nigeria. A retrospective cohort design was employed, reviewing records of 95 patients diagnosed with invasive candidiasis over a 36-month period. Clinical, microbiological, and pharmacological variables collected included Candida species, antifungal MIC, time to antifungal initiation, source control adequacy, underlying immunosuppression type, and APACHE II severity score. Survival analysis and logistic regression were used to identify independent predictors of 30-day mortality. The overall 30-day mortality was 48.4 percent. Independent predictors of poor outcome included Candida non-albicans species (OR: 2.9), fluconazole MIC above 2 mg/L (OR: 3.4), antifungal initiation beyond 48 hours of positive culture (OR: 4.1), and APACHE II score exceeding 20 (OR: 5.7). Echinocandin use was associated with improved survival compared to fluconazole (OR: 0.41 for death). These findings identify modifiable determinants of invasive candidiasis mortality and provide evidence supporting early empirical echinocandin therapy and species-guided treatment in immunocompromised patients managed in Kano and comparable resource-limited settings. Keywords: invasive candidiasis, antifungal outcomes, Candida species, echinocandin, immunocompromised.