{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"bioRxiv"}],"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T07:51:44Z","timestamp":1775893904579,"version":"3.50.1"},"posted":{"date-parts":[[2025,2,6]]},"group-title":"Microbiology","reference-count":74,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T00:00:00Z","timestamp":1738800000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,2,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:p>\n                  Invasive\n                  <jats:italic>Candida<\/jats:italic>\n                  bloodstream infections (candidemia) are a deadly global health threat. Rare\n                  <jats:italic>Candida<\/jats:italic>\n                  species are increasingly important causes of candidemia and phenotypic data, including patterns of antifungal drug resistance, is limited. There is geographic variation in the distribution of\n                  <jats:italic>Candida<\/jats:italic>\n                  species and frequency of antifungal drug resistance, which means that collecting and reporting regional data can have significant clinical value. Here, we report the first survey of species distribution, frequency of antifungal drug resistance, and phenotypic variability of\n                  <jats:italic>Candida<\/jats:italic>\n                  bloodstream isolates from an academic medical center and 5 affiliated hospitals in the Minneapolis-Saint Paul region of Minnesota, collected during an 18-month period from 2019 to 2021. We collected 288 isolates spanning 11 species from 119 patients.\n                  <jats:italic>C. albicans<\/jats:italic>\n                  was the most frequently recovered species, followed by\n                  <jats:italic>C. glabrata<\/jats:italic>\n                  and\n                  <jats:italic>C. parapsilosis<\/jats:italic>\n                  , with 10% of cases representing additional, rare species. We performed antifungal drug susceptibility for the three major drug classes and, concerningly, we identified fluconazole, micafungin and multidrug resistance rates in\n                  <jats:italic>C. glabrata<\/jats:italic>\n                  that were \u223c 2 times higher than that reported in other regions of the United States. We report some of the first phenotypic data in rare non-\n                  <jats:italic>albicans Candida<\/jats:italic>\n                  species. Through analysis of serial isolates from individual patients, we identified clinically relevant within-patient differences of MIC values in multiple drug classes. Our results provide valuable clinical data relevant to antifungal stewardship efforts and highlight important areas of future research, including within-patient dynamics of infection and the mechanisms of drug resistance in rare\n                  <jats:italic>Candida<\/jats:italic>\n                  species.\n                <\/jats:p>","DOI":"10.1101\/2025.02.05.636768","type":"posted-content","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T22:40:25Z","timestamp":1738881625000},"source":"Crossref","is-referenced-by-count":1,"title":["Heterogeneity of\n                  <i>Candida<\/i>\n                  bloodstream isolates in an academic medical center and affiliated hospitals"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1678-0796","authenticated-orcid":false,"given":"Nancy E.","family":"Scott","sequence":"first","affiliation":[{"name":"University of Minnesota, Bioinformatics and Computational Biology Program"},{"name":"University of Minnesota, Department of Microbiology and Immunology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Wash","sequence":"additional","affiliation":[{"name":"University of Minnesota, Department of Microbiology and Immunology"},{"name":"University of Minnesota, Molecular, Cellular, Developmental Biology and Genetics Program"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Zajac","sequence":"additional","affiliation":[{"name":"University of Minnesota, Department of Microbiology and Immunology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serin E.","family":"Erayil","sequence":"additional","affiliation":[{"name":"University of Minnesota, Department of Medicine, Division of Infectious Diseases and International Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan E.","family":"Kline","sequence":"additional","affiliation":[{"name":"University of Minnesota, Department of Medicine, Division of Infectious Diseases and International Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3298-2400","authenticated-orcid":false,"given":"Anna","family":"Selmecki","sequence":"additional","affiliation":[{"name":"University of Minnesota, Bioinformatics and Computational Biology Program"},{"name":"University of Minnesota, Department of Microbiology and Immunology"},{"name":"University of Minnesota, Molecular, Cellular, Developmental Biology and Genetics Program"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026041023573372000_2025.02.05.636768v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/0003-9969(80)90147-8"},{"key":"2026041023573372000_2025.02.05.636768v1.2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.29.8.1702-1710.1991"},{"key":"2026041023573372000_2025.02.05.636768v1.3","unstructured":"World Health Organization. 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