{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:01:04Z","timestamp":1790179264652,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T00:00:00Z","timestamp":1720742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Elite Researcher Grand Committee","award":["982822"],"award-info":[{"award-number":["982822"]}]},{"name":"Elite Researcher Grand Committee","award":["4000347"],"award-info":[{"award-number":["4000347"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Candidemia is a major cause of morbidity and mortality in health care settings, and its epidemiology is changing. In the last two decades, the proportion of non-albicans Candida (NAC) yeasts in candidemia has increased. These yeasts more often display resistance to common antifungals. In many western countries, candidemia is mainly caused by susceptible C. albicans, while in resource-limited countries, including Iran, the candidemia species distribution is studied less often. Here, we investigated the species distribution, resistance levels, and characteristics of patients with candidemia in five hospitals in Mashhad (northeast Iran) for two years (2019\u20132021). Yeast isolates from blood were identified with MALDI-TOF MS and subjected to antifungal susceptibility testing (AFST) using the broth microdilution method, while molecular genotyping was applied to Candida parapsilosis isolates. In total, 160 yeast isolates were recovered from 160 patients, of which the majority were adults (60%). Candidemia was almost equally detected in men (48%) and women (52%). Almost half of patients (n = 67, 49%) were from intensive care units (ICUs). C. parapsilosis (n = 58, 36%) was the most common causative agent, surpassing C. albicans (n = 52, 33%). The all-cause mortality rate was 53%, with C. albicans candidemia displaying the lowest mortality with 39%, in contrast to a mortality rate of 59% for NAC candidemia. With microbroth AFST, nearly all tested isolates were found to be susceptible, except for one C. albicans isolate that was resistant to anidulafungin. By applying short tandem repeat (STR) genotyping to C. parapsilosis, multiple clusters were found. To summarize, candidemia in Mashhad, Iran, from 2019 to 2021, is characterized by common yeast species, in particular C. parapsilosis, for which STR typing indicates potential nosocomial transmission. The overall mortality is high, while resistance rates were found to be low, suggesting that the high mortality is linked to limited diagnostic options and insufficient medical care, including the restricted use of echinocandins as the first treatment option.<\/jats:p>","DOI":"10.3390\/jof10070481","type":"journal-article","created":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T08:16:57Z","timestamp":1720772217000},"page":"481","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Epidemiology of Candidemia in Mashhad, Northeast Iran: A Prospective Multicenter Study (2019\u20132021)"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3862-8912","authenticated-orcid":false,"given":"Somayeh","family":"Dolatabadi","sequence":"first","affiliation":[{"name":"Department of Biology, Hakim Sabzevari University, Sabzevar 9617976487, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0590-1073","authenticated-orcid":false,"given":"Mohammad Javad","family":"Najafzadeh","sequence":"additional","affiliation":[{"name":"Department of Medical Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91766-99199, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas","family":"Raeisabadi","sequence":"additional","affiliation":[{"name":"Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari 48471-91628, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1449-4668","authenticated-orcid":false,"given":"Hossein","family":"Zarrinfar","sequence":"additional","affiliation":[{"name":"Allergy Research Center, Mashhad University of Medical Sciences, Mashhad 91766-99199, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahsa","family":"Jalali","sequence":"additional","affiliation":[{"name":"Department of Medical Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91766-99199, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6734-361X","authenticated-orcid":false,"given":"Bram","family":"Spruijtenburg","sequence":"additional","affiliation":[{"name":"Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands"},{"name":"Canisius-Wilhelmina Hospital (CWZ)\/Dicoon, 6532 SZ Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-024X","authenticated-orcid":false,"given":"Eelco F. J.","family":"Meijer","sequence":"additional","affiliation":[{"name":"Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands"},{"name":"Canisius-Wilhelmina Hospital (CWZ)\/Dicoon, 6532 SZ Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3253-6080","authenticated-orcid":false,"given":"Jacques F.","family":"Meis","sequence":"additional","affiliation":[{"name":"Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands"},{"name":"Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), Excellence Center for Medical Mycology (ECMM), University of Cologne, 50931 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2946-7785","authenticated-orcid":false,"given":"Cornelia","family":"Lass-Fl\u00f6rl","sequence":"additional","affiliation":[{"name":"Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Excellence Center for Medical Mycology (ECMM), 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5841-6461","authenticated-orcid":false,"given":"Theun","family":"de Groot","sequence":"additional","affiliation":[{"name":"Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands"},{"name":"Canisius-Wilhelmina Hospital (CWZ)\/Dicoon, 6532 SZ Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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. 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