{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T19:35:46Z","timestamp":1789414546836,"version":"build-2803163510"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"Summary objective<\/jats:title>To assess the clinical features and outcomes of hematological disease patients with Candida tropicalis<\/jats:italic> bloodstream infections and determine the antifungal susceptibility of C. tropicalis<\/jats:italic>.<\/jats:p><\/jats:sec>Methods<\/jats:title>This is a retrospective, single-center, observational study conducted in the Department of Hematology at The First Affiliated Hospital of Guangxi Medical University from January 2013 to December 2021. A total of 26 hematological disease patients with C. tropicalis<\/jats:italic> bloodstream infections were enrolled, and their clinical features, treatment plans, and prognoses were assessed. Univariate analysis was performed by Kaplan\u2013Meier analysis and multivariate analysis was conducted using a Cox regression model. The antifungal susceptibility of C. tropicalis<\/jats:italic> was determined from patient blood cultures.<\/jats:p><\/jats:sec>Results<\/jats:title>The patients had a mean age of 35\u2009years (range: 10\u201365\u2009years), 50% were male (13\/26) and 88.5% had hematologic malignancies (23\/26) while the remaining three patients included two cases of severe aplastic anemia and one case of \u03b2-thalassemia. All patients had neutropenia. Seven patients were initially given azole alone (26.9%), five of whom failed treatment and died (71.4%). Fifteen patients were treated with echinocandin (57.7%), three of whom failed treatment and died (20.0%), and eight patients were treated with amphotericin B (30.8%), two of whom failed treatment and died (25.0%). The total and attributable mortality rates were 42.3 and 34.6%, respectively. Univariate analysis showed that there are six risk factors for attributable deaths among hematological disease patients with C. tropicalis<\/jats:italic> blood infections. These risk factors included septic shock, Pitt bacteremia scores \u22654, procalcitonin levels \u226510\u2009ng\/mL, positive plasma (1,3)- \u03b2-D glucan assay, serum albumin levels &lt;30.0\u2009g\/L, time from fever to antifungal treatment initiation \u22655\u2009days and time between neutropenia and antifungal treatment \u226510\u2009days. Moreover, skin and mucosal infections and a treatment schedule that included amphotericin B and drug combinations are protective factors for attributable deaths. Multivariate analysis showed that septic shock (p<\/jats:italic> =\u20090.006) was an independent risk factor for attributable death. All isolates were sensitive to flucytosine and amphotericin B. The intermediate or resistance of C. tropicalis<\/jats:italic> to fluconazole, itraconazole and voriconazole were 41.7, 50, and 41.7%, respectively.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Hematological disease patients with C. tropicalis<\/jats:italic> bloodstream infections had a high mortality rate, and early antifungal therapy significantly reduced mortality. Candida tropicalis<\/jats:italic> was highly resistant to azole drugs and sensitive to flucytosine and amphotericin B. According to our study, the preferred agent is amphotericin B and drug combinations should be considered for severe infections.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmicb.2023.1092175","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T23:07:40Z","timestamp":1689376060000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["A clinical analysis of Candida tropicalis bloodstream infections associated with hematological diseases, and antifungal susceptibility: a retrospective survey"],"prefix":"10.3389","volume":"14","author":[{"given":"Beibei","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenbin","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meiqing","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongrong","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihua","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.1093\/cid\/ciz535","article-title":"Resilience of the Pitt bacteremia score: 3 decades and counting","volume":"70","author":"Al-Hasan","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1093\/mmy\/myz124","article-title":"Antifungal susceptibility, genotyping, resistance mechanism, and clinical profile of Candida tropicalis blood isolates","volume":"58","author":"Arastehfar","year":"","journal-title":"Med. Mycol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"587278","DOI":"10.3389\/fmicb.2020.587278","article-title":"Recent increase in the prevalence of fluconazole-non-susceptible Candida tropicalis blood isolates in Turkey: clinical implication of azole-non-susceptible and fluconazole tolerant phenotypes and genotyping","volume":"11","author":"Arastehfar","year":"","journal-title":"Front. Microbiol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"280","DOI":"10.3390\/jof7040280","article-title":"Candidemia among Iranian patients with severe COVID-19 admitted to ICUs","volume":"7","author":"Arastehfar","year":"2021","journal-title":"J Fungi (Basel)"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.jcrc.2012.07.011","article-title":"Attributable costs of patients with candidemia and potential implications of polymerase chain reaction-based pathogen detection on antifungal therapy in patients with sepsis","volume":"28","author":"Bloos","year":"2013","journal-title":"J. Crit. Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"575.e1","DOI":"10.1016\/j.cmi.2017.02.002","article-title":"Impact of ERG3 mutations and expression of ergosterol genes controlled by UPC2 and NDT80 in Candida parapsilosis azole resistance","volume":"23","author":"Branco","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.7504\/nk2016040305","article-title":"Analysis of clinical characteristics and attributable mortality of Candida tropicalis fungemia in patients with hematological","volume":"36","author":"Chao Zhi","year":"2016","journal-title":"Chin J Pract Internal Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1660","DOI":"10.3201\/eid2509.190520","article-title":"Clonality of fluconazole-nonsusceptible Candida tropicalis in bloodstream infections, Taiwan, 2011-2017","volume":"25","author":"Chen","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s10156-012-0412-9","article-title":"Fatal candidemia caused by azole-resistant Candida tropicalis in patients with hematological malignancies","volume":"18","author":"Chong","year":"2012","journal-title":"J. Infect. Chemother."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2014\/456878","article-title":"Virulence factors contributing to pathogenicity of candida tropicalis and its antifungal susceptibility profile","volume":"2014","author":"Deorukhkar","year":"2014","journal-title":"Int. J. Microbiol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/pathogens10010082","article-title":"Predominance of candida glabrata among non-albicans candida species in a 16-year study of candidemia at a tertiary care center in Lebanon","volume":"10","author":"El Zakhem","year":"2021","journal-title":"Pathogens"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"4769","DOI":"10.1128\/AAC.00477-13","article-title":"Candida tropicalis antifungal cross-resistance is related to different azole target (Erg11p) modifications","volume":"57","author":"Forastiero","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1186\/1471-2164-9-579","article-title":"MFS transportome of the human pathogenic yeast Candida albicans","volume":"9","author":"Gaur","year":"2008","journal-title":"BMC Genomics"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"35","DOI":"10.12037\/YXQY.2020.01-06","article-title":"Chinese consensus on the diagnosis and management of adult candidiasis","volume":"12","author":"Gui-Qiang","year":"2020","journal-title":"F Chinese Clin Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.jinf.2009.08.020","article-title":"Excess mortality, length of stay and cost attributable to candidaemia","volume":"59","author":"Hassan","year":"2009","journal-title":"J. Infect."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1007\/s10096-014-2230-8","article-title":"Candidemia in the intensive care unit: analysis of direct treatment costs and clinical outcome in patients treated with echinocandins or fluconazole","volume":"34","author":"Heimann","year":"2015","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"331","DOI":"10.22088\/jbums.23.1.331","article-title":"Molecular identification of Candida species in Bronchoalveolar lavage specimens of hospitalized children with pulmonary disorders","volume":"23","author":"Kashefi","year":"2021","journal-title":"J Babol Univ Med Sci"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.diagmicrobio.2019.05.017","article-title":"Poor prognosis of Candida tropicalis among non-albicans candidemia: a retrospective multicenter cohort study, Korea","volume":"95","author":"Ko","year":"2019","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1016\/j.cmi.2019.04.024","article-title":"Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis","volume":"25","author":"Koehler","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"i4","DOI":"10.1093\/jac\/dkx444","article-title":"Changes in the epidemiological landscape of invasive candidiasis","volume":"73","author":"Lamoth","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1007\/s00134-017-4743-y","article-title":"The risk and clinical outcome of candidemia depending on underlying malignancy","volume":"43","author":"Lortholary","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/s1471-4914(02)02280-3","article-title":"Molecular basis of resistance to azole antifungals","volume":"8","author":"Lupetti","year":"2002","journal-title":"Trends Mol. Med."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/j.jinf.2010.03.003","article-title":"Procalcitonin levels in surgical patients at risk of candidemia","volume":"60","author":"Martini","year":"2010","journal-title":"J. Infect."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3390\/jof7010013","article-title":"MixInYeast: a multicenter study on mixed yeast infections","volume":"7","author":"Medina","year":"2020","journal-title":"J Fungi (Basel)"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"2429","DOI":"10.1001\/archinte.1995.00430220087009","article-title":"Therapeutic approaches in patients with Candidemia","volume":"155","author":"Nguyen","year":"1995","journal-title":"Arch. Intern. Med."},{"key":"ref26","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":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1146\/annurev-micro-092611-150111","article-title":"Yeast ATP-binding cassette transporters conferring multidrug resistance","volume":"66","author":"Prasad","year":"2012","journal-title":"Annu. Rev. Microbiol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1007\/s13277-014-2649-7","article-title":"Invasive fungal infection in patients receiving chemotherapy for hematological malignancy: a multicenter, prospective, observational study in China","volume":"36","author":"Sun","year":"2015","journal-title":"Tumor Biol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1016\/j.cmi.2015.06.010","article-title":"Incidence and species distribution of candidaemia in Asia: a laboratory-based surveillance study","volume":"21","author":"Tan","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1086\/421946","article-title":"Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective Nationwide surveillance study","volume":"39","author":"Wisplinghoff","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"754","DOI":"10.3760\/cma.j.cn112138-20200627-00624","article-title":"The Chinese guidelines for the diagnosis and treatment of invasive fungal disease in patients with hematological disorders and cancers (the 6th revision)","volume":"59","author":"Xiaojun","year":"2020","journal-title":"Chin. J. Intern. Med."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1186\/s12879-020-05238-6","article-title":"Epidemiology, species distribution, and predictive factors for mortality of candidemia in adult surgical patients","volume":"20","author":"Zhang","year":"2020","journal-title":"BMC Infect. Dis."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1038\/s41368-018-0013-2","article-title":"ERG3 and ERG11 genes are critical for the pathogenesis of Candida albicans during the oral mucosal infection article. International","volume":"10","author":"Zhou","year":"2018","journal-title":"J. Oral Sci."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.3389\/fmicb.2017.01927","article-title":"An update on Candida tropicalis based on basic and clinical approaches","volume":"8","author":"Zuza-Alves","year":"2017","journal-title":"Front. 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