{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:37:16Z","timestamp":1792690636158,"version":"4.5.0"},"reference-count":40,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007700","name":"Carol Davila University of Medicine and Pharmacy","doi-asserted-by":"publisher","award":["28567\/02.10.2023"],"award-info":[{"award-number":["28567\/02.10.2023"]}],"id":[{"id":"10.13039\/501100007700","id-type":"DOI","asserted-by":"publisher"}]},{"award":["28567\/02.10.2023"],"award-info":[{"award-number":["28567\/02.10.2023"]}],"id":[{"id":"https:\/\/ror.org\/04fm87419","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Antifungal resistance among Candida species represents a growing clinical challenge, particularly in the context of increasing prevalence of non-albicans species. Methods: We conducted a retrospective analysis of 747 fungal isolates collected between 2021 and 2026, evaluating species distribution, antifungal susceptibility profiles, minimum inhibitory concentration (MIC) patterns, and temporal trends in resistance. Results: Non-albicans Candida species accounted for 67.5% of isolates, exceeding the proportion of Candida albicans. Fluconazole and flucytosine exhibited the highest resistance rates (16.1% and 17.4%, respectively), while amphotericin B showed the highest susceptibility rate (82.1%). MIC analysis revealed elevated MIC90 values for azoles in Candida glabrata and Candida krusei, consistent with reduced susceptibility. A significant association between antifungal agent and susceptibility profile was observed (\u03c72 = 33.81, p &lt; 0.001; Cram\u00e9r\u2019s V = 0.205). Temporal analysis demonstrated fluctuating resistance patterns rather than a consistent increase over time. Multidrug resistance was uncommon (2.5%), although non-susceptibility to multiple agents was more frequent (20.3%). Conclusions: The study highlights substantial variability in antifungal susceptibility across Candida species and antifungal agents, emphasizing the importance of continuous surveillance and species-specific treatment strategies.<\/jats:p>","DOI":"10.3390\/antibiotics15050440","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:46:11Z","timestamp":1777455971000},"page":"440","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Shifting Epidemiology and Antifungal Susceptibility Patterns of Clinical Fungal Isolates in an Intensive Care Unit (ICU) from Bucharest, Romania: A Retrospective Observational Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5927-7069","authenticated-orcid":false,"given":"Madalina (Preda)","family":"Solomon","sequence":"first","affiliation":[{"name":"Department of Microbiology, Parasitology and Virology, Faculty of Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Clinical Laboratory of Medical Microbiology, Marius Nasta Institute of Pneumology, 050159 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9240-922X","authenticated-orcid":false,"given":"Beatrice","family":"Mahler","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania"},{"name":"Pneumology Department, Marius Nasta Institute of Pneumology, 050159 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana","family":"Popescu","sequence":"additional","affiliation":[{"name":"National Reference Laboratory of Tuberculosis, Marius Nasta Institute of Pneumology, 050159 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lia-Mara","family":"Ditu","sequence":"additional","affiliation":[{"name":"Department of Botany and Microbiology, Faculty of Biology, University of Bucharest, Portocalilor 1-3, 060101 Bucharest, Romania"},{"name":"MICROGEN Research Centre, Faculty of Biology, University of Bucharest, Portocalilor 1-3, 060101 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Gheorghe-Barbu","sequence":"additional","affiliation":[{"name":"Department of Botany and Microbiology, Faculty of Biology, University of Bucharest, Portocalilor 1-3, 060101 Bucharest, Romania"},{"name":"Research Institute of the University of Bucharest, University of Bucharest, 050663 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Ioana","family":"Chivu","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, Faculty of Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8694-6195","authenticated-orcid":false,"given":"Loredana Sabina Cornelia","family":"Manolescu","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Parasitology and Virology, Faculty of Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Clinical Laboratory of Medical Microbiology, Marius Nasta Institute of Pneumology, 050159 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1128\/CMR.00029-06","article-title":"Epidemiology of Invasive Candidiasis: A Persistent Public Health Problem","volume":"20","author":"Pfaller","year":"2007","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_2","first-page":"29768675241304684","article-title":"A Narrative Review of Invasive Candidiasis in the Intensive Care Unit","volume":"19","author":"Eloff","year":"2024","journal-title":"Ther. Adv. Pulm. Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Vazquez, J.A., Whitaker, L., and Zubovskaia, A. (2025). Invasive Candidiasis in the Intensive Care Unit: Where Are We Now?. J. Fungi, 11.","DOI":"10.3390\/jof11040258"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S445","DOI":"10.1093\/infdis\/jix131","article-title":"Multidrug-Resistant Candida: Epidemiology, Molecular Mechanisms, and Treatment","volume":"216","author":"Arendrup","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Odoj, K., Garlasco, J., Pezzani, M.D., Magnabosco, C., Ortiz, D., Manco, F., Galia, L., Foster, S.K., Arieti, F., and Tacconelli, E. (2024). Tracking Candidemia Trends and Antifungal Resistance Patterns across Europe: An In-Depth Analysis of Surveillance Systems and Surveillance Studies. J. Fungi, 10.","DOI":"10.3390\/jof10100685"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Calvo, M., Scalia, G., and Trovato, L. (2024). Antifungal Susceptibility Data and Epidemiological Distribution of Candida spp.: An In Vitro Five-Year Evaluation at University Hospital Policlinico of Catania and a Comprehensive Literature Review. Antibiotics, 13.","DOI":"10.3390\/antibiotics13100914"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"myae041","DOI":"10.1093\/mmy\/myae041","article-title":"Candida glabrata (Nakaseomyces glabrata): A Systematic Review of Clinical and Microbiological Data from 2011 to 2021 to Inform the World Health Organization Fungal Priority Pathogens List","volume":"62","author":"Beardsley","year":"2024","journal-title":"Med. Mycol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1111\/jdv.20473","article-title":"The Conundrum of Antifungal Resistance: Emergence of Nakaseomyces glabratus (Candida glabrata) in Europe with Global Implications","volume":"39","author":"Gupta","year":"2025","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"32115","DOI":"10.1038\/s41598-025-15577-6","article-title":"Functional Roles of Purified Yapsins from Candida glabrata (Nakaseomyces glabratus) in Immune Modulation and Cross-Species Biofilm Formation","volume":"15","author":"Satala","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gabald\u00f3n, T., Martin, T., Marcet-Houben, M., Durrens, P., Bolotin-Fukuhara, M., Lespinet, O., Arnaise, S., Boisnard, S., Aguileta, G., and Atanasova, R. (2013). Comparative Genomics of Emerging Pathogens in the Candida glabrata Clade. BMC Genom., 14.","DOI":"10.1186\/1471-2164-14-623"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1038\/s44259-023-00007-2","article-title":"Molecular Mechanisms Governing Antifungal Drug Resistance","volume":"1","author":"Lee","year":"2023","journal-title":"npj Antimicrob. Resist."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"001518","DOI":"10.1099\/mic.0.001518","article-title":"Microbe Profile: Candida glabrata\u2014A Master of Deception","volume":"170","author":"Granada","year":"2024","journal-title":"Microbiology"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Whaley, S.G., Berkow, E.L., Rybak, J.M., Nishimoto, A.T., Barker, K.S., and Rogers, P.D. (2016). Azole Antifungal Resistance in Candida Albicans and Emerging Non-Albicans Candida Species. Front. Microbiol., 7.","DOI":"10.3389\/fmicb.2016.02173"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S612","DOI":"10.1093\/cid\/civ791","article-title":"Echinocandin Resistance in Candida","volume":"61","author":"Perlin","year":"2015","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6627","DOI":"10.1128\/AAC.03570-14","article-title":"The Production of Reactive Oxygen Species Is a Universal Action Mechanism of Amphotericin B against Pathogenic Yeasts and Contributes to the Fungicidal Effect of This Drug","volume":"58","author":"Casas","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"dlae153","DOI":"10.1093\/jacamr\/dlae153","article-title":"Wild-Type MIC Distributions and Epidemiological Cutoff Values for 5-Flucytosine and Candida Species as Determined by EUCAST Broth Microdilution","volume":"6","author":"Delma","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Su\u00e1rez-Urquiza, P., Pem\u00e1n, J., Gordon, M., Favier, P., Mu\u00f1oz-Brell, P., L\u00f3pez-Hontangas, J.L., and Ruiz-Gait\u00e1n, A. (2024). Predicting Fungemia in the ICU: Unveiling the Value of Weekly Fungal Surveillance and Yeast Colonisation Monitoring. J. Fungi, 10.","DOI":"10.3390\/jof10100674"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Soubani, A.O. (2026). An Evolving Challenge: Fungal Infections in the Contemporary ICU. J. Fungi, 12.","DOI":"10.3390\/jof12030197"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2846","DOI":"10.1128\/JCM.00937-12","article-title":"Progress in Antifungal Susceptibility Testing of Candida spp. by Use of Clinical and Laboratory Standards Institute Broth Microdilution Methods, 2010 to 2012","volume":"50","author":"Pfaller","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1093\/ofid\/ofy358","article-title":"Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Candida Species from 1997\u20132016","volume":"6","author":"Pfaller","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_21","first-page":"B4698","article-title":"Candida and Candidaemia. Susceptibility and Epidemiology","volume":"60","author":"Arendrup","year":"2013","journal-title":"Dan. Med. J."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Preda, M., and Manolescu, L.C.S. (2022). Romania, a Harbour of HIV-1 Subtype F1: Where Are We after 33 Years of HIV-1 Infection?. Viruses, 14.","DOI":"10.3390\/v14092081"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Wu, J., Jiang, C., Wang, H., Chen, T., Chen, X., and Da, W. (2026). The Pathogenicity and Future Treatment Strategies of Candida albicans. Front. Cell. Infect. Microbiol., 16.","DOI":"10.3389\/fcimb.2026.1752304"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"G\u00f3mez-Gaviria, M., Ram\u00edrez-Sotelo, U., and Mora-Montes, H.M. (2023). Non-Albicans Candida Species: Immune Response, Evasion Mechanisms, and New Plant-Derived Alternative Therapies. J. Fungi, 9.","DOI":"10.3390\/jof9010011"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Preda, M., Chivu, R.D., Ditu, L.M., Popescu, O., and Manolescu, L.S.C. (2024). Pathogenesis, Prophylaxis, and Treatment of Candida auris. Biomedicines, 12.","DOI":"10.3390\/biomedicines12030561"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1128\/JCM.40.3.852-856.2002","article-title":"SENTRY Participants Group Trends in Antifungal Susceptibility of Candida spp. Isolated from Pediatric and Adult Patients with Bloodstream Infections: SENTRY Antimicrobial Surveillance Program, 1997 to 2000","volume":"40","author":"Pfaller","year":"2002","journal-title":"J. Clin. Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"237","DOI":"10.2147\/IDR.S118892","article-title":"Fluconazole Resistance in Candida Species: A Current Perspective","volume":"10","author":"Berkow","year":"2017","journal-title":"Infect. Drug Resist."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Manolescu, L.S.C., Zugravu, C., Zaharia, C.N., Dumitrescu, A.I., Prasacu, I., Radu, M.C., Leti\u021bia, G.D., Nita, I., Cristache, C.M., and Gales, L.N. (2022). Barriers and Facilitators of Romanian HPV (Human Papillomavirus) Vaccination. Vaccines, 10.","DOI":"10.3390\/vaccines10101722"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4690","DOI":"10.1128\/AAC.03255-14","article-title":"Role of FKS Mutations in Candida glabrata: MIC Values, Echinocandin Resistance, and Multidrug Resistance","volume":"58","author":"Pham","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"249","DOI":"10.2147\/IDR.S124918","article-title":"Antifungal Resistance: Current Trends and Future Strategies to Combat","volume":"10","author":"Wiederhold","year":"2017","journal-title":"Infect. Drug Resist."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s40588-024-00219-8","article-title":"Emerging Antifungal Resistance in Fungal Pathogens","volume":"11","author":"Hui","year":"2024","journal-title":"Curr. Clin. Microbiol. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","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. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1056\/NEJMra1315399","article-title":"Invasive Candidiasis","volume":"373","author":"Kullberg","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_34","unstructured":"European Committee on Antimicrobial Susceptibility Testing (2026). Breakpoint Tables for Interpretation of MICs for Antifungal Agents, European Committee for Antimicrobial Susceptibility Testing."},{"key":"ref_35","first-page":"42","article-title":"Update on Antifungal Resistance in Aspergillus and Candida","volume":"20","author":"Arendrup","year":"2014","journal-title":"Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Cernat, E.M., Dima, A., Popescu, C., Neagu, A., Betianu, C., Moga, M., Manolescu, L.S.C., and Barbilian, A. (2024). Anterior Intercondylar Notch Geometry in Relation to the Native Anterior Cruciate Ligament Size. J. Clin. Med., 13.","DOI":"10.3390\/jcm13020309"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1007\/s00134-025-07793-5","article-title":"Are Contemporary Antifungal Doses Sufficient for Critically Ill Patients? Outcomes from an International, Multicenter Pharmacokinetics Study for Screening Antifungal Exposure in Intensive Care Units\u2014The SAFE-ICU Study","volume":"51","author":"Roberts","year":"2025","journal-title":"Intensive Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.jointm.2024.01.005","article-title":"Fungal Infections in Immunocompromised Critically Ill Patients","volume":"4","year":"2024","journal-title":"J. Intensive Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Hernandez-Reyes, F.B., Mu\u00f1oz-Miranda, L.A., Kirchmayr, M.R., Ortiz-Lazareno, P.C., Cort\u00e9s-Z\u00e1rate, R., I\u00f1iguez-Moreno, M., Jacobo-Cuevas, H., and Nava-Valdivia, C.A. (2025). Antifungal Susceptibility and Resistance-Associated Gene Expression in Nosocomial Candida Isolates. J. Fungi, 11.","DOI":"10.3390\/jof11120895"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.3390\/encyclopedia2040118","article-title":"Antifungals and Drug Resistance","volume":"2","author":"Hossain","year":"2022","journal-title":"Encyclopedia"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/5\/440\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:37:52Z","timestamp":1777459072000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/5\/440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["antibiotics15050440"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15050440","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]}}}