{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:00:55Z","timestamp":1789621255552,"version":"build-2803163510"},"reference-count":54,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T00:00:00Z","timestamp":1736208000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Infections with fluconazole\u2010resistant <jats:italic>Candida parapsilosis<\/jats:italic> have been increasing in Israeli hospitals with unclear implications for patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine the frequency, mechanisms, molecular epidemiology, and outcomes of azole\u2010resistant <jats:styled-content style=\"fixed-case\"><jats:italic>C. parapsilosis<\/jats:italic><\/jats:styled-content> bloodstream infections in four hospitals in Israel.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients\/Methods<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\"><jats:italic>C. parapsilosis<\/jats:italic><\/jats:styled-content> bloodstream isolates were collected at four hospitals in central Israel during varying periods from 2005 to 2022. Antifungal susceptibility testing was done using CLSI broth microdilution. Risk factors for fluconazole resistance were investigated using logistic regression. ERG11 gene sequencing was performed on all isolates. Genetic relatedness was determined using multilocus microsatellite genotyping. Clinical cure, microbiological eradication, and mortality rates were compared between fluconazole\u2010susceptible and resistant isolates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 192 patient\u2010specific <jats:styled-content style=\"fixed-case\"><jats:italic>C. parapsilosis<\/jats:italic><\/jats:styled-content> isolates were analysed. Resistance to fluconazole and voriconazole was detected in 80 (41%) and 14 (7.2%) isolates, respectively. The ERG11 Y132F substitution was found in 91% of fluconazole\u2010resistant and 1% of fluconazole\u2010susceptible isolates. Increasing age, intensive care hospitalisation, haemodialysis, and recent exposure to antibiotics were risk factors for fluconazole\u2010resistant <jats:styled-content style=\"fixed-case\"><jats:italic>C. parapsilosis<\/jats:italic><\/jats:styled-content>. Distinct but related genotypes predominated at each centre, indicating extensive dissemination within hospitals and limited transmission among them. Fluconazole resistance was associated with increased likelihood of microbiological failure but no significant difference in clinical cure and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found high rates of fluconazole resistance in <jats:styled-content style=\"fixed-case\"><jats:italic>C. parapsilosis<\/jats:italic><\/jats:styled-content>, attributable to nosocomial spread of hospital\u2010specific clones bearing the Y132F substitution. Fluconazole resistance was associated with a higher risk of microbiological but not clinical failure. Strategies to limit nosocomial transmission of <jats:styled-content style=\"fixed-case\"><jats:italic>C. parapsilosis<\/jats:italic><\/jats:styled-content> are needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.70017","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T05:36:42Z","timestamp":1736314602000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Inter\u2010Institutional Dynamics and Impact of Fluconazole\u2010Resistant <i>Candida parapsilosis<\/i>"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3276-0963","authenticated-orcid":false,"given":"Maya","family":"Korem","sequence":"first","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Diseases Hadassah Medical Center  Jerusalem Israel"},{"name":"Faculty of Medicine Hebrew University of Jerusalem  Jerusalem 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