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The widespread use of azoles and the shift toward non-albicans <jats:italic>Candida<\/jats:italic> (NAC) species remarkably increase azole resistance in developing countries. We aimed to study candidemia trends and associated risk factors in oncology patients since they vary geographically, and rapid and appropriate treatment improves outcomes. Vitek 2 was used to identify the <jats:italic>Candida<\/jats:italic> species, and the E-test determined their susceptibility to azoles. <jats:italic>Candida<\/jats:italic> was the cause of 3.1% (<jats:italic>n<\/jats:italic>\u2009=\u200953\/1701) of bloodstream infections (BSIs) during a 1-year study. <jats:italic>Candida tropicalis<\/jats:italic> was the most predominant species among the 30 candidemia episodes studied (36.7%), followed by <jats:italic>C. albicans<\/jats:italic> (33.3%). However, <jats:italic>C. krusei<\/jats:italic>, <jats:italic>C. guilliermondii<\/jats:italic>, <jats:italic>C. pelliculosa<\/jats:italic>, <jats:italic>C. parapsilosis<\/jats:italic>, <jats:italic>C. famata<\/jats:italic>, and <jats:italic>C. inconspicua<\/jats:italic> accounted for 30.0% of the isolates. An increased risk of NAC BSI was significantly associated with chemotherapy and leucopenia (<jats:italic>P<\/jats:italic>\u2009=\u20090.036 and 0.016, respectively). However, the multivariable analysis revealed that leucopenia was the only independent risk factor (<jats:italic>P<\/jats:italic>\u2009=\u20090.048). Fluconazole and voriconazole resistance were 58.3% and 16.7%, with NAC species showing higher resistance rates than <jats:italic>C. albicans<\/jats:italic>. Both fluconazole and voriconazole minimum inhibitory concentration (MIC) median values were higher in NAC than in <jats:italic>C. albicans<\/jats:italic>, but only voriconazole was significantly higher (0.220 versus 0.048\u00a0\u03bcg\/ml, <jats:italic>P<\/jats:italic>\u2009=\u20090.047). In conclusion, the increased prevalence of NAC BSIs and incredibly high fluconazole resistance rates in cancer patients emphasize the necessity of antifungal stewardship to preserve voriconazole effectiveness, continued surveillance of candidemia, and future studies into azole resistance molecular mechanisms.<\/jats:p>","DOI":"10.1007\/s00284-023-03468-w","type":"journal-article","created":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T04:01:30Z","timestamp":1696478490000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Alarming Increase of Azole-Resistant Candida Causing Blood Stream Infections in Oncology Patients in Egypt"],"prefix":"10.1007","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2887-8125","authenticated-orcid":false,"given":"Hadir A.","family":"El-Mahallawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2893-0744","authenticated-orcid":false,"given":"Nesma E.","family":"Abdelfattah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6221-7307","authenticated-orcid":false,"given":"Mona A.","family":"Wassef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2177-6153","authenticated-orcid":false,"given":"Rasha M.","family":"Abdel-Hamid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,5]]},"reference":[{"issue":"1","key":"3468_CR1","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s12941-021-00441-y","volume":"20","author":"YJ Zheng","year":"2021","unstructured":"Zheng YJ, Xie T, Wu L, Liu XY, Zhu L, Chen Y, Mao EQ, Han LZ, Chen EZ, Yang ZT (2021) Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital. 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