{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:18:22Z","timestamp":1787735902743,"version":"build-2784847793"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Candidozyma auris (C. auris) is an emerging multidrug-resistant yeast associated with healthcare-related transmission, difficult laboratory identification, antifungal resistance, and high mortality in critically ill patients. This study aimed to describe the clinical and microbiological characteristics of early institutional C. auris cases detected in a tertiary hospital in Istanbul, T\u00fcrkiye. Methods: Adult patients hospitalized between January 2021 and December 2022 with C. auris isolation were retrospectively reviewed. Demographic data, underlying conditions, intensive care unit (ICU) exposure, invasive procedures, antimicrobial and antifungal use, culture sources, antifungal susceptibility testing (AFST) results, and clinical outcomes were evaluated. C. auris isolates were identified using VITEK MS v.3.2, and AFST was performed using C. auris isolates were identified using VITEK MS v.3.2, and AFST was performed using Sensititre YeastOne YO10 (Thermo Fisher Scientific, Waltham, MA, USA) panels. Results were interpreted according to CDC interim breakpoints. Multiple isolates from an individual patient were retained when they represented different specimen types or sampling events. Results: Thirty-three adult patients and 62 clinical isolates were included. The mean age was 67.8 years, and 20 patients (60.6%) were aged 65 years or older. Most patients had prior ICU admission (93.9%), urinary catheterization (97.0%), central venous catheterization (90.9%), mechanical ventilation (81.8%), and broad-spectrum antimicrobial exposure. Blood cultures represented the most frequent source of isolation (56.5%), followed by urine cultures (27.4%). Resistance rates were 98.4% for amphotericin B, 88.7% for fluconazole, 6.6% for micafungin, and 6.5% for caspofungin. Overall mortality was 72.7%. While mortality was numerically higher among patients aged 65 years or older and those requiring inotropic support, only the need for mechanical ventilation was statistically significantly associated with mortality. The cohort-level APACHE II-based expected mortality was 48.0%, whereas observed mortality was 72.7%; this comparison was descriptive and no formal calibration analysis was performed. Conclusions: Early institutional C. auris cases in this tertiary hospital occurred predominantly among elderly, critically ill patients with prolonged healthcare exposure, invasive devices, and extensive antimicrobial use. The findings support the need for early laboratory recognition, cautious interpretation of commercial AFST results, particularly given the propensity of Sensititre YeastOne to overestimate amphotericin B resistance, strengthened infection control practices, and multicenter studies incorporating molecular typing to clarify transmission dynamics and antifungal resistance patterns.<\/jats:p>","DOI":"10.3390\/antibiotics15090824","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:00:48Z","timestamp":1787644848000},"page":"824","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Microbiological Characteristics of Early Candidozyma auris Cases in a Tertiary Hospital in Istanbul, T\u00fcrkiye: A Retrospective Case Series"],"prefix":"10.3390","volume":"15","author":[{"given":"Beg\u00fcm","family":"Nal\u00e7a Erdin","sequence":"first","affiliation":[{"name":"Department of Microbiology, Health Sciences University Dar\u0131ca Farabi Training and Research Hospital, 41700 Kocaeli, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5488-2262","authenticated-orcid":false,"given":"\u0130rfan","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Pharmacy Services Program, Pharmacy Services Department, Health Services Vocational School, Fenerbahce University, 34758 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1297-944X","authenticated-orcid":false,"given":"Y\u00fcksel","family":"Akkaya","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Health Sciences University \u00dcmraniye Training and Research Hospital, 34764 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meziyet Zeliha","family":"G\u00fcrlek Ustaba\u015f\u0131","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Resuscitation, Health Sciences University \u00dcmraniye Training and Research Hospital, 34764 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeliha","family":"Al\u0131c\u0131ku\u015f","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Resuscitation, Health Sciences University \u00dcmraniye Training and Research Hospital, 34764 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Turan","sequence":"additional","affiliation":[{"name":"General Intensive Care Unit, Ac\u0131badem Ata\u015fehir Hospital, 34642 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0272-5131","authenticated-orcid":false,"given":"\u0130brahim Halil","family":"K\u0131l\u0131\u00e7","sequence":"additional","affiliation":[{"name":"Department of Biology, Faculty of Arts and Sciences, Gaziantep University, 27310 Gaziantep, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Chowdhary, A., Sharma, C., and Meis, J.F. (2017). Candida auris: A rapidly emerging cause of hospital-acquired multidrug-resistant fungal infections globally. PLoS Pathog., 13.","DOI":"10.1371\/journal.ppat.1006290"},{"key":"ref_2","first-page":"28","article-title":"Candida auris: Microbiological characteristics and laboratory diagnosis of the hidden pathogen","volume":"11","author":"Uzun","year":"2022","journal-title":"Mediterr. J. Infect. Microb. Antimicrob."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ahmad, S., and Alfouzan, W. (2021). Candida auris: Epidemiology, diagnosis, pathogenesis, antifungal susceptibility, and infection control measures to combat the spread of infections in healthcare facilities. Microorganisms, 9.","DOI":"10.3390\/microorganisms9040807"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1080\/21501203.2023.2227218","article-title":"Risk factors and mortality of the newly emerging Candida auris in a university hospital in Saudi Arabia","volume":"14","author":"Kaki","year":"2023","journal-title":"Mycology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.ijmmb.2021.03.007","article-title":"Candida auris fungemia and a local spread taken under control with infection control measures: First report from Turkey","volume":"39","author":"Kurt","year":"2021","journal-title":"Indian J. Med. Microbiol."},{"key":"ref_6","unstructured":"Republic of T\u00fcrkiye Ministry of Health, General Directorate of Public Health (2026, March 01). Sa\u011fl\u0131k Hizmetlerinde Candida auris; Ankara, T\u00fcrkiye, 2025, Available online: https:\/\/hsgm.saglik.gov.tr\/media\/attachments\/2025\/05\/14\/saGlik-hIzmetlerInde-c.auris.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"648","DOI":"10.5578\/mb.20219716","article-title":"T\u00fcrkiye\u2019de ilk COVID-19 pozitif Candida auris fungemi olgusu","volume":"55","author":"Orhun","year":"2021","journal-title":"Mikrobiyol. Bul."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s11046-023-00782-6","article-title":"Nosocomial infection of C. auris in a COVID-19 intensive care unit in T\u00fcrkiye and phylogenetic analysis of isolates","volume":"188","author":"Ekren","year":"2023","journal-title":"Mycopathologia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"452","DOI":"10.5578\/mb.20219814","article-title":"T\u00fcrkiye \u0130stanbul\u2019dan bildirilen \u00fc\u00e7 Candida auris olgusu [Three Candida auris case reports from Istanbul, Turkey]","volume":"55","author":"Ceylan","year":"2021","journal-title":"Mikrobiyol. Bul."},{"key":"ref_10","first-page":"48","article-title":"The second case of Candida auris candidemia from Turkey: An impending threat to global health","volume":"10","author":"Teke","year":"2021","journal-title":"Mediterr. J. Infect. Microb. Antimicrob."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"207","DOI":"10.5144\/0256-4947.2025.207","article-title":"Identification and antifungal resistance profiling of Candida (Candidozyma) auris in a tertiary hospital in Istanbul, T\u00fcrkiye","volume":"45","author":"Akkaya","year":"2025","journal-title":"Ann. Saudi Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s12941-025-00821-8","article-title":"Biocide, antifungal susceptibility and virulence characteristics of Clade 1 Candidozyma auris strains","volume":"24","author":"Kalkanci","year":"2025","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"313","DOI":"10.5144\/0256-4947.2025.313","article-title":"Detection of Candida (Candidozyma) auris by molecular methods and investigation of clinical symptoms of patients in a tertiary hospital in Istanbul","volume":"45","author":"Akkaya","year":"2025","journal-title":"Ann. Saudi Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bhargava, A., Klamer, K., Sharma, M., Ortiz, D., and Saravolatz, L. (2025). Candida auris: A continuing threat. Microorganisms, 13.","DOI":"10.3390\/microorganisms13030652"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1186\/s13054-025-05544-y","article-title":"Candida auris infections in ICU patients: Risk factors, outcomes, and antifungal resistance patterns","volume":"29","author":"Choudhury","year":"2025","journal-title":"Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hu, S., Zhu, F., Jiang, W., Wang, Y., Quan, Y., Zhang, G., Gu, F., and Yang, Y. (2021). Retrospective analysis of the clinical characteristics of Candida auris infection worldwide from 2009 to 2020. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.658329"},{"key":"ref_17","unstructured":"Centers for Disease Control and Prevention (2026, March 01). Antifungal Susceptibility Testing for C. auris, Available online: https:\/\/www.cdc.gov\/candida-auris\/hcp\/laboratories\/antifungal-susceptibility-testing.html."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e163","DOI":"10.1017\/ash.2025.10064","article-title":"Geographical variation in the clinical profile of patients with Candida auris","volume":"5","author":"Schieber","year":"2025","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"161","DOI":"10.63729\/TJIC.2025.657","article-title":"Rational use of intensive care beds in Turkey: Point prevalence survey study","volume":"23","author":"Utku","year":"2025","journal-title":"Turk. J. Intensive Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/j.1651-2227.2005.tb01791.x","article-title":"Seasonality of invasive Candida infection in neonates","volume":"94","author":"Emmerson","year":"2005","journal-title":"Acta Paediatr."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Donders, G.G., Ruban, K., Donders, F., and Reybrouck, R. (2022). Lab-based retrospective 10-year analysis shows seasonal variation of vaginal Candida infection rates in Belgium. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030574"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Di Carlo, P., Serra, N., Collotta, O., Colomba, C., Firenze, A., Aprea, L., Distefano, S.A., Cortegiani, A., Giammanco, G., and Fasciana, T.M.A. (2025). The influence of the seasonal variability of Candida spp. bloodstream infections and antifungal treatment: A Mediterranean pilot study. Antibiotics, 14.","DOI":"10.3390\/antibiotics14050452"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"myaf019","DOI":"10.1093\/mmy\/myaf019","article-title":"Comparison of broth microdilution and Etest methods for susceptibility testing of amphotericin B in Candida auris","volume":"63","author":"Li","year":"2025","journal-title":"Med. Mycol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e0443122","DOI":"10.1128\/spectrum.04431-22","article-title":"Overestimation of amphotericin B resistance in Candida auris with Sensititre YeastOne antifungal susceptibility testing: A need for adjustment for correct interpretation","volume":"11","author":"Siopi","year":"2023","journal-title":"Microbiol. Spectr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1016\/j.cmi.2025.04.003","article-title":"How does antifungal resistance vary in Candida (Candidozyma) auris and its clades? Quantitative and qualitative analyses and their clinical implications","volume":"31","author":"Lucini","year":"2025","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.7754\/Clin.Lab.2024.240317","article-title":"Antifungal susceptibility testing and cluster analysis of Candida auris strains","volume":"70","author":"Ozmerdiven","year":"2024","journal-title":"Clin. Lab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.cmi.2025.07.002","article-title":"How to interpret MICs of amphotericin B, echinocandins and flucytosine against Candida auris (Candidozyma auris) according to the newly established European Committee for Antimicrobial Susceptibility Testing (EUCAST) breakpoints","volume":"32","author":"Arendrup","year":"2026","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_28","first-page":"e69699","article-title":"Mortality and associated risk factors in patients with Candida auris: Insights from a tertiary care hospital in Bahrain","volume":"16","author":"Alagha","year":"2024","journal-title":"Cureus"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","article-title":"APACHE II: A severity of disease classification system","volume":"13","author":"Knaus","year":"1985","journal-title":"Crit. Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e00358-25","DOI":"10.1128\/aac.00358-25","article-title":"Managing Candida auris fungemias: The results of a prospective and international study","volume":"69","author":"Erdem","year":"2025","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"G\u00fclten, E., \u00c7\u0131nar, G., Sar\u0131cao\u011flu, E.M., Akdemir, \u0130., Y\u0131lmaz, A.Z., Saldere, E.H., and Y\u00f6r\u00fck, F. (2025). Candida auris vs. non-Candida auris candidemia in critically ill patients: Clinical outcomes, risk factors, and mortality. J. Fungi, 11.","DOI":"10.3390\/jof11080552"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1007\/s00134-020-06240-x","article-title":"Invasive candidiasis in critical care: Challenges and future directions","volume":"46","author":"Logan","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s00134-017-5043-2","article-title":"Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP)","volume":"44","author":"Vincent","year":"2018","journal-title":"Intensive Care Med."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/9\/824\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:30:25Z","timestamp":1787733025000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/9\/824"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["antibiotics15090824"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15090824","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]}}}