{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:46:25Z","timestamp":1791812785964,"version":"4.3.4"},"reference-count":43,"publisher":"American Society for Microbiology","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Future talent program of Zunyi Medical University","award":["Rc220211223"],"award-info":[{"award-number":["Rc220211223"]}],"id":[{"id":"https:\/\/ror.org\/00g5b0g93","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Science and Technology Project of Zunyi","award":["Zunshikehe HZ zi (2023) 278"],"award-info":[{"award-number":["Zunshikehe HZ zi (2023) 278"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["mSystems"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      The clinical significance of\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species isolation from sputum remains ambiguous due to the colonization-infection dilemma. Integrating quantitative culture with microbiome profiling may clarify its role, yet systematic evidence is scarce. In this exploratory study (June 2023\u2013June 2026), we enrolled 140 hospitalized patients suspected of invasive pulmonary candidiasis (IPC) and stratified them into possible IPC (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 36), probable IPC (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 71), and negative control (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 33) groups based on clinical criteria. All underwent quantitative fungal culture of sputum and metagenomic next-generation sequencing (mNGS). Patients were stratified by sputum\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species load into low (&lt;10\n                      <jats:sup>5<\/jats:sup>\n                      CFU\/mL), high (\u226510\n                      <jats:sup>5<\/jats:sup>\n                      CFU\/mL), and negative control (0 CFU\/mL) groups. We investigated associations between\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species burden, respiratory microbiota, local inflammation (IL-8), and clinical outcomes. Higher\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species load was significantly associated with prolonged hospitalization, elevated sputum IL-8, an increased microbial dysbiosis index, and depletion of key commensals (e.g.,\n                      <jats:italic toggle=\"yes\">Neisseria, Prevotella, Rothia, Streptococcus, and Veillonella<\/jats:italic>\n                      ). Counterintuitively, it correlated negatively with several classic bacterial pathogens (such as\n                      <jats:italic toggle=\"yes\">Acinetobacter baumannii<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Mycobacterium tuberculosis<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      ). A random forest model identified a nine-species microbiome signature that effectively discriminated probable from possible IPC (AUC, 0.877; 95% CI, 0.662\u20130.944). In patients with suspected IPC, higher sputum\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species load is associated with exacerbated respiratory dysbiosis and airway inflammation. Quantitative\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species assessment combined with microbiome signatures may serve as a complementary tool for stratifying disease severity and ecological disruption, meriting further validation in larger, multicenter cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      Respiratory specimens dominate clinical fungal cultures, yet interpreting the role of\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      spp. in sputum remains a diagnostic dilemma. Here, by integrating quantitative culture with metagenomic sequencing, we show that a high sputum\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species load is a marker of profound ecological disruption. High\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species burden was associated with significant depletion of key commensals, an elevated dysbiosis index, and heightened local inflammation. Counterintuitively, it correlated negatively with several classic bacterial pathogens, revealing a distinct dysbiotic signature. Moreover, a microbiome-based model accurately discriminated patients with probable invasive pulmonary candidiasis. Our findings suggest that quantitative sputum\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species load, interpreted within the context of the microbial community, may be a practical biomarker for identifying patients with significant respiratory dysbiosis and inflammation, offering a path toward more refined, ecology-informed therapeutic strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/msystems.00837-26","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:01:00Z","timestamp":1791810060000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Association of quantitative sputum\n                    <i>Candida<\/i>\n                    load with respiratory dysbiosis and airway inflammation in suspected invasive pulmonary candidiasis"],"prefix":"10.1128","author":[{"given":"Guangli","family":"Wang","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g5b0g93","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University","place":["Zunyi, China"]},{"id":[{"id":"https:\/\/ror.org\/00g5b0g93","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Laboratory Medicine, Zunyi Medical University","place":["Zunyi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningqing","family":"Zhang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00g5b0g93","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University","place":["Zunyi, China"]},{"id":[{"id":"https:\/\/ror.org\/00g5b0g93","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Laboratory Medicine, Zunyi Medical 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