{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:10:16Z","timestamp":1785496216666,"version":"3.56.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T00:00:00Z","timestamp":1683849600000},"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>Objective<\/jats:title><jats:p>Opportunistic fungal infections by <jats:italic>Candida<\/jats:italic> species arise among cancer patients due to the weakened immune system following extensive chemotherapy. Prophylaxis with antifungal agents have developed the resistance of <jats:italic>Candida<\/jats:italic> spp. to antifungals. Accurate identification of yeasts and susceptibility patterns are main concerns that can directly effect on the treatment of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Over a period of three years, 325 cancer patients suspected to <jats:italic>Candida<\/jats:italic> infections were included in the current investigation. The clinical isolates were molecularly identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). All strains, were examined for <jats:italic>in vitro<\/jats:italic> susceptibility to the amphotericin B, itraconazole, fluconazole, and anidulafungin according to the CLSI M27 document.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy-four cancer patients had <jats:italic>Candida<\/jats:italic> infections (22.7%). <jats:italic>Candida albicans<\/jats:italic> was the most common species (83.8%). Antifungal susceptibility results indicated that 100% of the <jats:italic>Candida<\/jats:italic> isolates were sensitive to amphotericin B; however, 17.6%, 9.4%, and 5.4% of clinical isolates were resistant to anidulafungin, fluconazole, and itraconazole, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The findings of the present work shows a warning increase in resistance to echinocandins. Since all fluconazole resistance isolates were obtained from candidemia, we recommend amphotericin B as the first line therapy for this potentially fatal infection.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2023.1152552","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T06:12:09Z","timestamp":1683871929000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["A 3-year study of Candida infections among patients with malignancy: etiologic agents and antifungal susceptibility profile"],"prefix":"10.3389","volume":"13","author":[{"given":"Mahdieh","family":"Sharifi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parisa","family":"Badiee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahdi","family":"Abastabar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid","family":"Morovati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iman","family":"Haghani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahta","family":"Noorbakhsh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasoul","family":"Mohammadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s12879-017-2916-5","article-title":"Identification of uncommon oral yeasts from cancer patients by MALDI-TOF mass spectrometry","volume":"18","author":"Aslani","year":"2018","journal-title":"BMC Infect. Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1177\/2040620711410098","article-title":"Invasive fungal infections in acute leukemia","volume":"2","author":"Bhatt","year":"2011","journal-title":"Ther. Adv. Hematol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.1093\/jac\/dkz568","article-title":"MIC distributions for amphotericin b, fluconazole, itraconazole, voriconazole, flucytosine and anidulafungin and 35 uncommon pathogenic yeast species from the UK determined using the CLSI broth microdilution method","volume":"75","author":"Borman","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis697","article-title":"Changes in incidence and antifungal drug resistance in candidemia: results from population-based laboratory surveillance in Atlanta and Baltimore, 2008-2011","volume":"55","author":"Cleveland","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"B5","volume-title":"Reference method for broth dilution antifungal susceptibility testing of yeasts","author":"Wayne","year":"2017"},{"key":"B6","volume-title":"Reference method for broth dilution antifungal susceptibility testing of yeasts","author":"Wayne","year":"2017"},{"key":"B7","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1111\/dote.12354","article-title":"Acid suppressing therapy as a risk factor for candida esophagitis","volume":"29","author":"Daniell","year":"2016","journal-title":"Dis. Esophagus"},{"key":"B8","doi-asserted-by":"publisher","first-page":"737","DOI":"10.3109\/13693786.2013.800239","article-title":"Identification and antifungal susceptibility of a large collection of yeast strains isolated in Tunisian hospitals","volume":"51","author":"Eddouzi","year":"2013","journal-title":"Med. Mycol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e954","DOI":"10.1016\/j.ijid.2010.04.006","article-title":"Relative frequency of albicans and the various non-albicans candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review","volume":"14","author":"Falagas","year":"2010","journal-title":"Int. J. Infect. Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1111\/myc.12024","article-title":"Candiduria in haematologic malignancy patients without a urinary catheter: nothing more than a frailty marker","volume":"56","author":"Georgiadou","year":"2013","journal-title":"Mycoses"},{"key":"B11","doi-asserted-by":"publisher","first-page":"100484","DOI":"10.1016\/j.genrep.2019.100484","article-title":"Molecular identification of candida species, assessment of the antifungal susceptibility and the genetic relationship of candida albicans isolated from immunocompromised patients in kerman, Iran","volume":"17","author":"Hamzehee","year":"2019","journal-title":"Gene Rep."},{"key":"B12","first-page":"143","article-title":"Five common cancers in Iran","volume":"13","author":"Kolahdoozan","year":"2010","journal-title":"Arch. Iran Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1086\/338404","article-title":"Pulmonary candidiasis in patients with cancer: an autopsy study","volume":"34","author":"Kontoyiannis","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1543","DOI":"10.1093\/carcin\/8.10.1543","article-title":"Possible mycological etiology of oral mucosal cancer: catalytic potential of infecting Candida aibicans and other yeasts in production of N - nitrosobenzylmethylamine","volume":"8","author":"Krogh","year":"1987","journal-title":"Carcinogenesis"},{"key":"B15","article-title":"Oral Candida colonization and infection in cancer patients and their antifungal susceptibility in a tertiary care hospital Int","volume":"2","author":"Lone","year":"2014","journal-title":"J. Adv. Res"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5812\/jjm.103290","article-title":"Oral candidiasis in hematological malignancy patients: identification and antifungal susceptibility patterns of isolates","volume":"13","author":"Mardani","year":"2020","journal-title":"Jundishapur J. Microbiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"102","DOI":"10.3855\/jidc.9634","article-title":"Distribution and antifungal susceptibility pattern of candida species at a tertiary hospital in Malaysia","volume":"12","author":"Mohamed","year":"2018","journal-title":"J. Infect. Dev. Ctries"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics9050227","article-title":"Review on current status of echinocandins use","volume":"9","author":"Mroczy\u0144ska","year":"2020","journal-title":"Antibiotics (Basel)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0101510","article-title":"Epidemiology and outcomes of invasive candidiasis due to non-albicans species of candida in 2,496 patients: data from the prospective antifungal therapy (PATH) registry 2004-2008","volume":"9","author":"Pfaller","year":"2014","journal-title":"PloS One"},{"key":"B21","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1128\/AAC.02020-13","article-title":"Multicenter study of anidulafungin and micafungin MIC distributions and epidemiological cutoff values for eight candida species and the CLSI M27-A3 broth microdilution method","volume":"58","author":"Pfaller","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"B22","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.jmii.2015.01.005","article-title":"Epidemiology, antifungal susceptibilities, and risk factors for invasive candidiasis from 2011 to 2013 in a teaching hospital in southwest China","volume":"50","author":"Pu","year":"2017","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"B23","doi-asserted-by":"publisher","first-page":"3112","DOI":"10.5897\/AJMR12.2257","article-title":"Trend of candida infection and antifungal resistance in a tertiary care hospital of north east India","volume":"7","author":"Roy","year":"2013","journal-title":"Afr. J. Microbiol. Res."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.9734\/BJMMR\/2015\/20171","article-title":"Proton pump inhibitors and corticosteroids as synergistic risk factors for candida esophagitis","volume":"10","author":"Shah","year":"2015","journal-title":"J. Adv. Med. Med. Res."},{"key":"B25","first-page":"376","article-title":"In vitro antifungal susceptibility profiles of candida albicans complex isolated from patients with respiratory infections","volume":"54","author":"Sharifynia","year":"2016","journal-title":"Acta Med. Iran"},{"key":"B26","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1590\/S1516-89132012000200020","article-title":"Rapid yeast DNA extraction by boiling and freeze-thawing without using chemical reagents and DNA purification","volume":"55","author":"Silva","year":"2012","journal-title":"Braz. Arch. Biol. Technol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"3743","DOI":"10.1128\/JCM.00942-07","article-title":"DNA Microarray-based detection and identification of fungal pathogens in clinical samples from neutropenic patients","volume":"45","author":"Spiess","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1093\/mmy\/myv114","article-title":"Antifungal susceptibility of invasive candida bloodstream isolates from the Asia-pacific region","volume":"54","author":"Tan","year":"2016","journal-title":"Med. Mycol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1182\/asheducation-2013.1.423","article-title":"Treatment of fungal disease in the setting of neutropenia","volume":"2013","author":"Walsh","year":"2013","journal-title":"Hematol. Am. Soc. Hematol. Educ. Program"},{"key":"B30","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/B978-0-12-372180-8.50042-1","article-title":"Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics","volume":"18","author":"White","year":"1990","journal-title":"PCR protocols: guide to Methods applications"},{"key":"B31","doi-asserted-by":"publisher","first-page":"95","DOI":"10.2147\/TCRM.S40160","article-title":"Epidemiology and risk factors for invasive candidiasis","volume":"10","author":"Yapar","year":"2014","journal-title":"Ther. Clin. Risk Manage."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2023.1152552\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T06:12:16Z","timestamp":1683871936000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2023.1152552\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,12]]},"references-count":31,"alternative-id":["10.3389\/fcimb.2023.1152552"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2023.1152552","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,12]]},"article-number":"1152552"}}