{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:09:47Z","timestamp":1785424187983,"version":"3.56.0"},"reference-count":21,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100004515","name":"Universiti Kebangsaan Malaysia","doi-asserted-by":"publisher","award":["FF 2019-076"],"award-info":[{"award-number":["FF 2019-076"]}],"id":[{"id":"10.13039\/501100004515","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,3,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Candidemia is a major cause of morbidity and mortality worldwide. The rising prevalence of non-albicans\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species (NACs), which often show diverse antifungal susceptibility, complicates treatment. This study aimed to characterize the species distribution and antifungal susceptibility of\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      isolates from candidemia cases on the east coast of Peninsular Malaysia and to evaluate the reliability of Etest compared to Sensititre YeastOne (SYO). A cross-sectional study collected 143\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      blood culture isolates from several hospitals on the east coast of Peninsular Malaysia between February 2019 and January 2020. Species identification was performed using conventional methods and MALDI-TOF MS. Antifungal susceptibility testing was conducted with SYO and Etest. MIC results were interpreted using CLSI and EUCAST guidelines. Agreement between methods was assessed by essential and categorical agreement and error rates. NACs predominated (82%), with\n                      <jats:italic toggle=\"yes\">C. parapsilosis<\/jats:italic>\n                      (27.3%),\n                      <jats:italic toggle=\"yes\">C. tropicalis<\/jats:italic>\n                      (24.5%), and\n                      <jats:italic toggle=\"yes\">C. glabrata<\/jats:italic>\n                      (21%). Echinocandins and amphotericin B showed high susceptibility rates (96.2% and 91.5%, respectively). Azole resistance was notable, especially in\n                      <jats:italic toggle=\"yes\">C. tropicalis<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">C. glabrata<\/jats:italic>\n                      . Etest demonstrated an inconsistent agreement with SYO, particularly for fluconazole and anidulafungin, with high major and very major error rates. NACs dominate candidemia in Malaysia\u2019s east coast, with significant azole resistance, while echinocandins and amphotericin B remain effective. Comparative analysis demonstrated poor agreement and elevated error rates for Etest relative to SYO, particularly for azoles and anidulafungin, indicating its unreliability as a stand-alone method. Continued local surveillance and validated AFST methods are critical to guide effective antifungal therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      This study highlights the evolving epidemiology of candidemia in Malaysia's east coast, marked by rising dominance of drug-resistant non-albicans\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      species. Findings underscore the value of reliable susceptibility testing, demonstrating that the widely used Etest method may misclassify resistance status, potentially impacting treatment choices. These insights inform stewardship efforts and clinical management in resource-constrained settings.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.02170-25","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T14:01:56Z","timestamp":1769695316000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["Antifungal susceptibility profiles of candidemia isolates on the east coast of Peninsular Malaysia and reliability of Etest compared to Sensititre YeastOne"],"prefix":"10.1128","volume":"14","author":[{"given":"Siti Nur Syuhadah","family":"Abdullah","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00bw8d226","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6073-2815","authenticated-orcid":true,"given":"Mohd Nizam","family":"Tzar","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00bw8d226","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7616-6491","authenticated-orcid":true,"given":"Siti Norlia","family":"Othman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00bw8d226","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss7404a1"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens14080806"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.4103\/apjtm.apjtm_559_24"},{"key":"e_1_3_3_5_2","first-page":"961","article-title":"Antifungal susceptibility patterns among Candida species isolated in Universiti Kebangsaan Malaysia Medical Centre","volume":"41","author":"Siti Umairah H","year":"2012","unstructured":"Siti Umairah H, Sharon T, Siti Nurwani AR, Mohd Syazwan CS, Ramliza R, Tzar MN. 2012. Antifungal susceptibility patterns among Candida species isolated in Universiti Kebangsaan Malaysia Medical Centre. Sains Malays 41:961\u2013967.","journal-title":"Sains Malays"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(24)00749-7"},{"key":"e_1_3_3_7_2","first-page":"61","article-title":"Candidaemia and antifungal susceptibility testing in a teaching hospital","volume":"64","author":"Tzar MN","year":"2009","unstructured":"Tzar MN, Shamim AS. 2009. Candidaemia and antifungal susceptibility testing in a teaching hospital. Med J Malays 64:61\u201364.","journal-title":"Med J Malays"},{"key":"e_1_3_3_8_2","first-page":"343","article-title":"Species distribution and antifungal susceptibility patterns of Candida species: is low susceptibility to itraconazole a trend in Malaysia?","volume":"68","author":"Santhanam J","year":"2013","unstructured":"Santhanam J, Yahaya N, Aziz MN. 2013. Species distribution and antifungal susceptibility patterns of Candida species: is low susceptibility to itraconazole a trend in Malaysia?. Med J Malays 68:343\u2013347.","journal-title":"Med J Malays"},{"key":"e_1_3_3_9_2","volume-title":"CLSI supplement M27M44SPerformance standards for antifungal susceptibility testing of yeasts","author":"CLSI","year":"2022","unstructured":"CLSI. 2022. CLSI supplement M27M44S. Performance standards for antifungal susceptibility testing of yeasts. 3rd ed. Clinical and Laboratory Standards Institute, Wayne, PA.","edition":"3"},{"key":"e_1_3_3_10_2","unstructured":"The European Committee on Antimicrobial Susceptibility Testing. 2023. Method for susceptibility testing of yeasts version 7.4. Available from: https:\/\/www.eucast.org\/astoffungi\/methodsinantifungalsusceptibilitytesting\/susceptibility_testing_of_yeasts\/"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3390\/jof5040108"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.3906\/sag-1909-97"},{"key":"e_1_3_3_13_2","unstructured":"The European Committee on Antimicrobial Susceptibility Testing. 2024. Breakpoint tables for interpretation of MICs for antifungal agents version 11.0. Available from: http:\/\/www.eucast.org\/astoffungi\/clinicalbreakpointsforantifungals\/"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.631865"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.027631-0"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlaf106"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1080\/20002297.2025.2559024"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/cells12222655"},{"key":"e_1_3_3_19_2","unstructured":"Thermo Fisher Scientific. Sensititre YeastOne YO10 manual. Thermo Fisher Scientific Inc. Available from: https:\/\/www.thermofisher.com\/order\/catalog\/product\/SYO. Retrieved 06 Jan 2019."},{"key":"e_1_3_3_20_2","unstructured":"bioM\u00e9rieux. ETEST antimicrobial susceptibility testing instruction manual. Available from: https:\/\/health.maryland.gov\/laboratories\/docs\/Etest%20information.pdf. Retrieved 05 Jan 2019."},{"key":"e_1_3_3_21_2","first-page":"71","article-title":"Antifungal susceptibility of molecularly confirmed Aspergillus species from clinical samples","volume":"46","author":"Tzar MN","year":"2024","unstructured":"Tzar MN, Mustakim S, Yusoff H, Tap RM. 2024. Antifungal susceptibility of molecularly confirmed Aspergillus species from clinical samples. Malays J Pathol 46:71\u201378.","journal-title":"Malays J Pathol"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01934-17"}],"container-title":["Microbiology Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.02170-25","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.02170-25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T14:09:07Z","timestamp":1772546947000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.02170-25"}},"subtitle":[],"editor":[{"given":"Ping","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":21,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,3]]}},"alternative-id":["10.1128\/spectrum.02170-25"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.02170-25","relation":{},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]},"assertion":[{"value":"2025-07-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e02170-25"}}