{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:22:02Z","timestamp":1789474922153,"version":"build-2803163510"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T00:00:00Z","timestamp":1631664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The incidence of invasive candidiasis is increasing worldwide. However, the epidemiology, antifungal susceptibility, and virulence of <jats:italic>Candida<\/jats:italic> spp. in most hospitals remain unclear. This study aimed to evaluate invasive candidiasis in a tertiary care hospital in Nanchang City, China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>MALDI-TOF MS and 18S rDNA ITS sequencing were used to identify <jats:italic>Candida<\/jats:italic> strains. Randomly amplified polymorphic DNA analysis was used for molecular typing; biofilm production, caseinase, and hemolysin activities were used to evaluate virulence. The Sensititre\u2122 YeastOne YO10 panel was used to examine antifungal susceptibility. Mutations in <jats:italic>ERG11<\/jats:italic> and the hotspot regions of <jats:italic>FKS1<\/jats:italic> of drug-resistant strains were sequenced to evaluate the possible mechanisms of antifungal resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We obtained 110 <jats:italic>Candida<\/jats:italic> strains, which included 40 <jats:italic>Candida albicans<\/jats:italic> (36.36%), 37 C. <jats:italic>parapsilosis<\/jats:italic> (33.64%), 21 C. <jats:italic>tropicalis<\/jats:italic> (19.09%), 9 C. <jats:italic>glabrata<\/jats:italic> (8.18%), 2 C. <jats:italic>rugose<\/jats:italic> (1.82%), and 1 C. <jats:italic>haemulonii<\/jats:italic> (0.91%) isolates. At a limiting point of 0.80, <jats:italic>C<\/jats:italic>. <jats:italic>albicans<\/jats:italic> isolates could be grouped into five clusters, <jats:italic>C<\/jats:italic>. <jats:italic>parapsilosis<\/jats:italic> and <jats:italic>C<\/jats:italic>. <jats:italic>tropicalis<\/jats:italic> isolates into seven clusters, and <jats:italic>C<\/jats:italic>. <jats:italic>glabrata<\/jats:italic> isolates into only one cluster comprising six strains by RAPD typing. Antifungal susceptibility testing revealed that the isolates showed the greatest overall resistance against fluconazole (6.36%), followed by voriconazole (4.55%). All <jats:italic>C<\/jats:italic>. <jats:italic>albicans<\/jats:italic> and <jats:italic>C<\/jats:italic>. <jats:italic>parapsilosis<\/jats:italic> isolates exhibited 100% susceptibility to echinocandins (i.e., anidulafungin, caspofungin, and micafungin), whereas one <jats:italic>C<\/jats:italic>. <jats:italic>glabrata<\/jats:italic> strain was resistant to echinocandins. The most common amino acid substitutions noted in our study was 132aa (Y132H, Y132F) in the azole-resistant strains. No missense mutation was identified in the hotpot regions of <jats:italic>FKS1<\/jats:italic>. Comparison of the selected virulence factors detectable in a laboratory environment, such as biofilm, caseinase, and hemolysin production, revealed that most <jats:italic>Candida<\/jats:italic> isolates were caseinase and hemolysin producers with a strong activity (Pz &amp;lt; 0.69). Furthermore, <jats:italic>C. parapsilosis<\/jats:italic> had greater total biofilm biomass (average Abs<jats:sub>620<\/jats:sub> = 0.712) than <jats:italic>C. albicans<\/jats:italic> (average Abs<jats:sub>620<\/jats:sub> = 0.214, p &amp;lt; 0.01) or <jats:italic>C. tropicalis<\/jats:italic> (average Abs<jats:sub>620<\/jats:sub> = 0.450, <jats:italic>p<\/jats:italic> &amp;lt; 0.05), although all <jats:italic>C. glabrata<\/jats:italic> strains were either low- or no-biofilm producers. The virulence level of the isolates from different specimen sources or clusters showed no obvious correlation. Interesting, 75% of the <jats:italic>C. albicans<\/jats:italic> from cluster F demonstrated azole resistance, whereas two azole-resistant <jats:italic>C. tropicalis<\/jats:italic> strains belonged to the cluster Y.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study provides vital information regarding the epidemiology, pathogenicity, and antifungal susceptibility of <jats:italic>Candida<\/jats:italic> spp. in patients admitted to Nanchang City Hospital.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2021.721439","type":"journal-article","created":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T11:01:19Z","timestamp":1631703679000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":26,"title":["Molecular Epidemiology, Antifungal Susceptibility, and Virulence Evaluation of Candida Isolates Causing Invasive Infection in a Tertiary Care Teaching Hospital"],"prefix":"10.3389","volume":"11","author":[{"given":"Junzhu","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niya","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongzhi","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomin","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuping","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongcheng","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjun","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaotian","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingbing","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1093\/mmy\/myw028","article-title":"Analysis of Virulence Factors and In Vivo Biofilm-Forming Capacity of Yarrowia Lipolytica Isolated From Patients With Fungemia","volume":"55","author":"Abbes","year":"2017","journal-title":"Med. 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