{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:00:22Z","timestamp":1790182822226,"version":"4.1.0"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Candidemia represent a significant cause of morbidity and mortality in hospitalized patients. Mortality depends on the virulence and resistance profile of the organism. This study aimed to evaluate virulence factors in Candida species isolated from bloodstream infections and correlate them with antifungal resistance patterns and clinical outcomes. 100 Candida isolates from blood cultures were collected over 1 year. Virulence factors including hemolysin, phospholipase, and proteinase activities, along with biofilm formation, were assessed. Susceptibility to antifungal was assessed using the VITEK\u00ae2 system. Clinical data and outcomes were analysed in relation to virulence factors and resistance patterns. Non-albicans Candida species (NAC) predominated (90%) over Candida albicans (10%). Candida parapsilosis (32%), and C. tropicalis (30%) were the most common NAC species. Overall, hemolysin activity was detected in 79% of isolates, phospholipase in 51%, proteinase in 43%, and biofilm formation in 87%. Candida auris and C. duobushaemulonii demonstrated the strongest virulence factor expression. Fluconazole resistance was observed in 22% of isolates, with C. auris showing 100% resistance. Isolates with stronger enzymatic activities and biofilm formation showed significantly higher antifungal resistance (P &amp;lt; .0001). The crude mortality rate was 27%, with significantly higher mortality in patients infected with resistant isolates and those expressing strong virulence factors (P &amp;lt; .05). NAC species have emerged as predominant causative agents of candidemia, demonstrating higher virulence factor expression and antifungal resistance compared to\u00a0C. albicans. The correlation between virulence factors, antifungal resistance, and mortality highlights the importance of species-level identification and antifungal susceptibility testing for optimal management of candidemia.<\/jats:p>","DOI":"10.1093\/mmy\/myag096","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:50:21Z","timestamp":1788954621000},"source":"Crossref","is-referenced-by-count":0,"title":["Association of virulence factors with antifungal resistance and clinical outcomes in\n                    <i>Candida species<\/i>\n                    isolated from bloodstream infections"],"prefix":"10.1093","volume":"64","author":[{"given":"Wanshisha Daphi","family":"Wanswett","sequence":"first","affiliation":[{"name":"Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , New Delhi 110002 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheetal","family":"Goenka","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , New Delhi 110002 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6976-3853","authenticated-orcid":false,"given":"Manisha","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , New Delhi 110002 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poonam","family":"Loomba","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , New Delhi 110002 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anirban Hom","family":"Choudhuri","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia & Intensive Care, Safdarjung Hospital & Vardhman Mahavir Medical College (VMMC) , New Delhi 110029 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abha","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , New Delhi 110002 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivani","family":"Tyagi","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , New Delhi 110002 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"issue":"7","key":"2026092312024926700_bib1","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1093\/jac\/dkad139","article-title":"Invasive candidiasis: Current clinical challenges and unmet needs in adult populations","volume":"78","author":"Soriano","year":"2023","journal-title":"J Antimicrob Chemother"},{"issue":"12","key":"2026092312024926700_bib2","doi-asserted-by":"publisher","first-page":"1804","DOI":"10.3390\/antibiotics11121804","article-title":"How to identify invasive candidemia in ICU\u2014A narrative review","volume":"11","author":"Alves","year":"2022","journal-title":"Antibiotics (Basel)"},{"issue":"1","key":"2026092312024926700_bib3","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1186\/s12879-025-11021-2","article-title":"Epidemiological characteristics, antifungal susceptibility, and mortality factors of candidemia in adults at a tertiary teaching hospital in Zunyi, China (2016\u20132023)","volume":"25","author":"Chen","year":"2025","journal-title":"BMC Infect Dis"},{"issue":"4","key":"2026092312024926700_bib4","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1111\/myc.13054","article-title":"Changes in the relative prevalence of Candidaemia due to non-albicans Candida species in adult in-patients: A systematic review, meta-analysis and meta-regression","volume":"63","author":"Giacobbe","year":"2020","journal-title":"Mycoses"},{"issue":"6","key":"2026092312024926700_bib5","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.3390\/microorganisms10061208","article-title":"Continuing shifts in epidemiology and antifungal susceptibility highlight the need for improved disease management of invasive candidiasis","volume":"10","author":"Parslow","year":"2022","journal-title":"Microorganisms"},{"issue":"5","key":"2026092312024926700_bib6","doi-asserted-by":"publisher","first-page":"e0216250","DOI":"10.1371\/journal.pone.0216250","article-title":"Changing trends in epidemiology and antifungal susceptibility patterns of six bloodstream Candida species isolates over a 12-year period in Kuwait","volume":"14","author":"Khan","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"2026092312024926700_bib7","doi-asserted-by":"publisher","first-page":"11597","DOI":"10.1038\/s41598-024-61813-w","article-title":"Antifungal susceptibility and virulence determinants profile of Candida species isolated from patients with candidemia","volume":"14","author":"Dawoud","year":"2024","journal-title":"Sci Rep"},{"issue":"2","key":"2026092312024926700_bib8","doi-asserted-by":"publisher","first-page":"272","DOI":"10.3390\/microorganisms13020272","article-title":"Candidiasis: Insights into virulence factors, complement evasion and antifungal drug resistance","volume":"13","author":"Gaffar","year":"2025","journal-title":"Microorganisms"},{"issue":"1","key":"2026092312024926700_bib9","first-page":"00140","article-title":"Virulence traits contributing to pathogenicity of Candida species","volume":"5","author":"Deorukhkar","year":"2017","journal-title":"J Microbiol Exp"},{"issue":"1","key":"2026092312024926700_bib10","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s12929-017-0376-2","article-title":"Virulence factors, antifungal susceptibility and molecular mechanisms of azole resistance among Candida parapsilosis complex isolates recovered from clinical specimens","volume":"24","author":"Neji","year":"2017","journal-title":"J Biomed Sci"},{"issue":"5","key":"2026092312024926700_bib11","doi-asserted-by":"publisher","first-page":"280","DOI":"10.7883\/yoken.JJID.2007.280","article-title":"Phospholipase and proteinase activities in different Candida species isolated from anatomically distinct sites of healthy adults","volume":"60","author":"Oksuz","year":"2007","journal-title":"Jpn J Infect Dis"},{"key":"2026092312024926700_bib12","doi-asserted-by":"publisher","first-page":"102237","DOI":"10.1016\/j.mib.2022.102237","article-title":"Antifungal drug-resistance mechanisms in Candida biofilms","volume":"71","author":"Kaur","year":"2023","journal-title":"Curr Opin Microbiol"},{"issue":"10","key":"2026092312024926700_bib13","doi-asserted-by":"publisher","first-page":"955","DOI":"10.3390\/jof9100955","article-title":"Biofilm formation in medically important Candida species","volume":"9","author":"Malinovsk\u00e1","year":"2023","journal-title":"J Fungi (Basel)"},{"key":"2026092312024926700_bib14","doi-asserted-by":"publisher","first-page":"100126","DOI":"10.1016\/j.bioflm.2023.100126","article-title":"Antifungal therapy of Candida biofilms: Past, present and future","volume":"5","author":"Ajetunmobi","year":"2023","journal-title":"Biofilm"},{"issue":"S1","key":"2026092312024926700_bib15","doi-asserted-by":"publisher","first-page":"s89","DOI":"10.1017\/ash.2024.228","article-title":"Resistance to antifungals in non-albicans Candida species isolates in the southeast region","volume":"4","author":"Pineda","year":"2024","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"issue":"3","key":"2026092312024926700_bib16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3892\/mmr.2025.13612","article-title":"Antifungal resistance: Emerging mechanisms and implications (review)","volume":"32","author":"Kadariswantiningsih","year":"2025","journal-title":"Mol Med Rep"},{"issue":"1","key":"2026092312024926700_bib17","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1186\/s12866-024-03515-x","article-title":"Characterization of Candida species isolated from clinical specimens: Insights into virulence traits, antifungal resistance and molecular profiles","volume":"24","author":"Makled","year":"2024","journal-title":"BMC Microbiol"},{"issue":"10","key":"2026092312024926700_bib18","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.3390\/diagnostics13101699","article-title":"Different BD BACTEC\u2122 blood culture bottle types for the detection of fungi in simulated sterile body fluid samples","volume":"13","author":"Tomazin","year":"2023","journal-title":"Diagnostics"},{"issue":"47","key":"2026092312024926700_bib19","doi-asserted-by":"publisher","first-page":"2948","DOI":"10.14260\/jemds\/2016\/687","article-title":"Evaluation of VITEK 2 system for clinical identification of Candida species and their antifungal susceptibility test","volume":"5","author":"Sundaram","year":"2016","journal-title":"J Evol Med Dent Sci"},{"key":"2026092312024926700_bib20","article-title":"Performance Standards for Antifungal Susceptibility Testing of Yeasts","author":"Clinical and Laboratory Standards Institute (CLSI)","year":"2022.","edition":"3rd ed."},{"key":"2026092312024926700_bib21","article-title":"Epidemiological Cutoff Values for Antifungal Susceptibility Testing","volume-title":"CLSI supplement M57S.","author":"Clinical and Laboratory Standards Institute (CLSI)","year":"2022","edition":"4th ed."},{"issue":"2","key":"2026092312024926700_bib22","doi-asserted-by":"publisher","first-page":"153","DOI":"10.14194\/ijmbr.1211","article-title":"In vitro evaluation of proteinase, phospholipase and haemolysin activities of Candida species isolated from clinical specimens","volume":"1","author":"Sachin","year":"2012","journal-title":"Int J Med Biomed Res"},{"issue":"1","key":"2026092312024926700_bib23","doi-asserted-by":"publisher","first-page":"56","DOI":"10.4103\/mamcjms.mamcjms_10_21","article-title":"Biofilm formation in methicillin-resistant and methicillin-sensitive Staphylococcus aureus strains","volume":"8","author":"Singhal","year":"2022","journal-title":"MAMC J Med Sci"},{"issue":"1","key":"2026092312024926700_bib24","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.eimc.2016.04.003","article-title":"Assessment of biofilm production in Candida isolates according to species and origin of infection","volume":"35","author":"Guembe","year":"2017","journal-title":"Enferm Infecc Microbiol Clin"},{"issue":"3","key":"2026092312024926700_bib25","doi-asserted-by":"publisher","first-page":"167","DOI":"10.4103\/cjhr.cjhr_12_20","article-title":"Candidemia\u2014Changing trends from Candida albicans to non-albicans Candida from a tertiary care center in western UP, India","volume":"7","author":"Ahmed","year":"2020","journal-title":"Chrismed J Health Res"},{"issue":"03","key":"2026092312024926700_bib26","first-page":"255","article-title":"Spectrum of Candidal species isolated from neonates admitted in an Intensive Care Unit of teaching hospital of Kashmir, North India","volume":"10","author":"Nazir","year":"2018","journal-title":"J Lab Phys"},{"issue":"11","key":"2026092312024926700_bib27","first-page":"e83954","article-title":"Epidemiology and antifungal susceptibility of Candida bloodstream isolates from a tertiary care center in Central India","volume":"17","author":"Bhadade","year":"2025","journal-title":"Cureus"},{"issue":"3","key":"2026092312024926700_bib28","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.30574\/wjarr.2025.28.3.3655","article-title":"Evolving landscape of candidemia in India: species shift, antifungal resistance, and clinical impact: narrative review","volume":"28","author":"Sheerin","year":"2025","journal-title":"World J Adv Res Rev"},{"key":"2026092312024926700_bib29","doi-asserted-by":"publisher","first-page":"1001845","DOI":"10.3389\/fmicb.2022.1001845","article-title":"Antifungal susceptibility profiles and drug resistance mechanisms of clinical Candida duobushaemulonii isolates from China","volume":"13","author":"Chen","year":"2022","journal-title":"Front Microbiol"},{"issue":"6","key":"2026092312024926700_bib30","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1590\/0074-02760160166","article-title":"Candida duobushaemulonii: An emerging rare pathogenic yeast isolated from recurrent vulvovaginal candidiasis in Brazil","volume":"111","author":"Boatto","year":"2016","journal-title":"Mem Inst Oswaldo Cruz"},{"issue":"2","key":"2026092312024926700_bib31","first-page":"189","article-title":"Candida albicans the main opportunistic pathogenic fungus in humans","volume":"55","author":"Macias-Paz","year":"2023","journal-title":"Rev Argent Microbiol"},{"issue":"4","key":"2026092312024926700_bib32","first-page":"2154","article-title":"Association of virulence factors with antifungal resistance in Candida species isolated from various clinical specimens","volume":"12","author":"Singh","year":"2023","journal-title":"Int J Life Sci"},{"key":"2026092312024926700_bib33","article-title":"Antimicrobial\u2013resistant invasive candidiasis","author":"Centers for Disease Control and Prevention","year":"2024"},{"issue":"1","key":"2026092312024926700_bib34","doi-asserted-by":"publisher","first-page":"4917","DOI":"10.1038\/s41598-025-88656-3","article-title":"Molecular characterization of some multidrug resistant Candida auris in Egypt","volume":"15","author":"Ahmed","year":"2025","journal-title":"Sci Rep"},{"issue":"3","key":"2026092312024926700_bib35","doi-asserted-by":"publisher","first-page":"652","DOI":"10.3390\/microorganisms13030652","article-title":"Candida auris: A continuing threat","volume":"13","author":"Bhargava","year":"2025","journal-title":"Microorganisms"},{"issue":"1","key":"2026092312024926700_bib36","doi-asserted-by":"publisher","first-page":"myae122","DOI":"10.1093\/mmy\/myae122","article-title":"Mortality patterns in candidemia: Insights from a multispecies analysis using a global research network","volume":"63","author":"Thompson","year":"2024","journal-title":"Med Mycol"},{"issue":"1","key":"2026092312024926700_bib37","doi-asserted-by":"publisher","first-page":"11597","DOI":"10.1038\/s41598-024-61813-w","article-title":"Antifungal susceptibility and virulence determinants profile of Candida species isolated from patients with candidemia","volume":"14","author":"Dawoud","year":"2024","journal-title":"Sci Rep"},{"issue":"4","key":"2026092312024926700_bib38","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical practice guideline for the management of Candidiasis: 2016 Update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin Infect Dis"}],"container-title":["Medical Mycology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mmy\/advance-article-pdf\/doi\/10.1093\/mmy\/myag096\/71018969\/myag096.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mmy\/article-pdf\/64\/9\/myag096\/71018969\/myag096.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mmy\/article-pdf\/64\/9\/myag096\/71018969\/myag096.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:02:52Z","timestamp":1790179372000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mmy\/article\/doi\/10.1093\/mmy\/myag096\/8789940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,29]]},"references-count":38,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,8,29]]}},"URL":"https:\/\/doi.org\/10.1093\/mmy\/myag096","relation":{},"ISSN":["1369-3786","1460-2709"],"issn-type":[{"value":"1369-3786","type":"print"},{"value":"1460-2709","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,8,29]]},"article-number":"myag096"}}