{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T03:59:47Z","timestamp":1782705587152,"version":"3.54.5"},"reference-count":61,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Background: Community-onset fungemia is a clinically significant syndrome frequently linked to recent healthcare exposure and significant morbidity and mortality. Methods: We performed a 21-year, single-centre retrospective cohort of consecutive yeast bloodstream infections diagnosed at the Emergency Department (2004\u20132024). Clinical\/epidemiological data, species identification (MALDI-TOF MS), antifungal susceptibility (CLSI M27; Sensititre YO10), and whole-genome sequencing (WGS) were analyzed. Results: Forty-eight episodes (51 isolates) were included; 56.3% were male, median age 74 years (IQR 63\u201382). Acquisition was healthcare-associated in 38\/48 (79.2%). Sources were unknown (36.7%), abdominal (22.4%), urological (22.4%), catheter-related (14.3%), and 2.1% was attributed to a cardiovascular and a joint focus; 18.8% were polymicrobial. Crude mortality was 20.8% at 7 days (10\/48) and 29.2% at 30 days (14\/48). Species distribution: Candida albicans 41.2%, Nakaseomyces glabratus 27.5%, Candida parapsilosis 11.8%, Candida tropicalis 11.8%, Pichia kudriavzevii 3.9%, Clavispora lusitaniae 1.9%, and Candida orthopsilosis 1.9%. No isolate was resistant to anidulafungin, micafungin, or amphotericin B; one N. glabratus showed reduced susceptibility to caspofungin. Azole resistance was observed in one C. albicans and one N. glabratus isolate. WGS (44 isolates) confirmed MALDI-TOF identifications and characterized resistance markers. All 12 sequenced N. glabratus carried ERG2 I207V, PDR15\/PDH1 E839D, and PDR1 V91I\/L98S. Notable cases included one N. glabratus caspofungin-intermediate with FKS2 F659C, N. glabratus fluconazole-resistant with multiple PDR1 substitutions including a unique novel G857V, and C. albicans fluconazole-resistant harbouring alterations in MRR1\/MRR2, CDR1, and ERG11. Conclusions: In this 21-year cohort, community-onset fungemia was predominantly healthcare-associated, with C. albicans as the predominant species, followed by N. glabratus. Crude mortality reached 29.2% at 30 days. Echinocandin resistance was not observed; azole resistance was uncommon. WGS provided precise speciation and actionable insight into resistance mechanisms, including a putatively novel PDR1 G857V in N. glabratus.<\/jats:p>","DOI":"10.3390\/jof11110808","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T16:46:22Z","timestamp":1763138782000},"page":"808","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Community-Onset Fungemias: Epidemiology and Genomic Characterization at a Tertiary-Care Hospital in Barcelona, Spain"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9277-414X","authenticated-orcid":false,"given":"Celso Soares Pereira","family":"Batista","sequence":"first","affiliation":[{"name":"Department of Genetics and Microbiology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vall\u00e8s), Spain"},{"name":"Microbiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9709-6162","authenticated-orcid":false,"given":"Alba","family":"Rivera","sequence":"additional","affiliation":[{"name":"Department of Genetics and Microbiology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vall\u00e8s), Spain"},{"name":"Microbiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Teresa","family":"Alvarez Albarran","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4811-0642","authenticated-orcid":false,"given":"Marc","family":"Rubio","sequence":"additional","affiliation":[{"name":"Microbiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Belen-Figas","sequence":"additional","affiliation":[{"name":"Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Lopez-Querol","sequence":"additional","affiliation":[{"name":"Microbiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2781-6926","authenticated-orcid":false,"given":"Elisenda","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Department of Genetics and Microbiology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vall\u00e8s), Spain"},{"name":"Microbiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4302-2838","authenticated-orcid":false,"given":"Ferran","family":"Navarro","sequence":"additional","affiliation":[{"name":"Department of Genetics and Microbiology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vall\u00e8s), Spain"},{"name":"Microbiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6800-5487","authenticated-orcid":false,"given":"Ferran","family":"Sanchez-Reus","sequence":"additional","affiliation":[{"name":"Microbiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1128\/AAC.01079-10","article-title":"Candida Bloodstream Infections: Comparison of Species Distributions and Antifungal Resistance Patterns in Community-Onset and Nosocomial Isolates in the SENTRY Antimicrobial Surveillance Program, 2008\u20132009","volume":"55","author":"Pfaller","year":"2011","journal-title":"Antimicrob. 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