{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T05:17:25Z","timestamp":1788585445215,"version":"build-2803163510"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010804","name":"Faculty of Medicine, Prince of Songkla University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010804","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/0575ycz84","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Fungi","JoF"],"abstract":"<jats:p>Invasive candidiasis (IC) causes substantial mortality in critically ill children, yet pediatric data from Southeast Asia remain limited. We retrospectively studied 117 children aged \u2264 18 years with proven IC at a Thai tertiary center (2009\u20132023). Thirty-day mortality was 25.6%, rising to 47.1% in neonates; death occurred a median of 5.5 days after diagnosis. Firth penalized logistic regression identified septic shock (aOR, 4.89; 95% CI, 1.77\u201314.88) and thrombocytopenia (aOR, 3.74; 95% CI, 1.17\u201315.35) as independent mortality predictors, with septic shock remaining significant across all analytical frameworks, including Fine\u2013Gray competing-risks analysis. Apparent mortality associated with absence of antifungal therapy reflected reverse causation: in all six untreated children who died, Candida was reported only 2\u20137 days after death. Candida albicans (43.6%), C. tropicalis (30.8%), and C. parapsilosis (24.8%) predominated; C. glabrata was absent. Non-albicans Candida was already common at the outset and showed no statistically detectable increase over 15 years. Among 45 consecutive pediatric bloodstream isolates (2021\u20132026), amphotericin B and echinocandins largely retained activity, whereas reduced azole susceptibility was concentrated in C. tropicalis (47.8% fluconazole-susceptible; 26.1% posaconazole wild-type). The reduced azole susceptibility of local C. tropicalis isolates argues for periodic reassessment of institutional susceptibility data rather than reliance on historical or external epidemiology; in comparable settings, an echinocandin or amphotericin B is a more reliable empiric choice than an azole, pending species identification and susceptibility results.<\/jats:p>","DOI":"10.3390\/jof12090664","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:10:33Z","timestamp":1788430233000},"page":"664","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent Non-albicans Predominance, High Mortality, and Azole-Non-Susceptible Candida tropicalis: A 15-Year Pediatric Invasive Candidiasis Cohort in Southern Thailand"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8680-9860","authenticated-orcid":false,"given":"Puttichart","family":"Khantee","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6825-658X","authenticated-orcid":false,"given":"Kochakorn","family":"Pinichkijpaisal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6438-2202","authenticated-orcid":false,"given":"Mingkwan","family":"Yingkajorn","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9907-6106","authenticated-orcid":false,"given":"Therdpong","family":"Thongseiratch","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand"},{"name":"Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6428-2305","authenticated-orcid":false,"given":"Kamolwish","family":"Laoprasopwattana","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/INF.0000000000002530","article-title":"Etiology and Outcome of Candidemia in Neonates and Children in Europe: An 11-year Multinational Retrospective Study","volume":"39","author":"Warris","year":"2020","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Hsu, J.F., Lai, M.Y., Lee, C.W., Chu, S.M., Wu, I.H., Huang, H.R., Lee, I.T., Chiang, M.C., Fu, R.H., and Tsai, M.H. (2018). Comparison of the incidence, clinical features and outcomes of invasive candidiasis in children and neonates. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3100-2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1093\/jpids\/pix046","article-title":"Epidemiology of Invasive Fungal Disease in Children","volume":"6","author":"Pana","year":"2017","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/INF.0000000000002912","article-title":"Pediatric and Neonatal Invasive Candidiasis: Species Distribution and Mortality Rate in a Thai Tertiary Care Hospital","volume":"40","author":"Jantarabenjakul","year":"2021","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Niyomthammarat, C., Meesilpavikkai, K., Chintanapakdee, W., Sophonphan, J., Anugulruengkitt, S., Puthanakit, T., and Jantarabenjakul, W. (2026). Temporal trends and clinical outcomes of pediatric invasive fungal diseases: A ten-year retrospective study from a tertiary-care center in Thailand. BMC Infect. Dis.","DOI":"10.1186\/s12879-026-13849-8"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Korem, M., Taragin, A., Dror, D., Temper, V., and Averbuch, D. (2023). A 14-Year Cohort of Candidemia in the Pediatric Population in a Tertiary Center in Jerusalem: Clinical Characteristics, Antifungal Susceptibility, and Risk Factors for Mortality. J. Fungi, 9.","DOI":"10.3390\/jof9121171"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ekemen, C., Celtik, U., Kiran Tasci, E., Cebeci, K., Yasar Duman, M., Karauzum, S.E., Guner Ozenen, G., Ozek, G., Karadas, N., and Ataseven, E. (2026). Clinical Characteristics, Management, and 30-Day Mortality Predictors in an 18-Year Pediatric Candidemia Cohort. J. Fungi, 12.","DOI":"10.3390\/jof12060445"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s10096-021-04394-0","article-title":"Mortality-associated factors of candidemia: A multi-center prospective cohort in Turkey","volume":"41","author":"Kutlu","year":"2022","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"502","DOI":"10.21873\/invivo.14214","article-title":"Risk Factors of Mortality in Older Patients with Candidemia","volume":"40","author":"Chen","year":"2026","journal-title":"In Vivo"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Lucignano, B., Cento, V., Agosta, M., Ambrogi, F., Albitar-Nehme, S., Mancinelli, L., Mattana, G., Onori, M., Galaverna, F., and Di Chiara, L. (2022). Effective Rapid Diagnosis of Bacterial and Fungal Bloodstream Infections by T2 Magnetic Resonance Technology in the Pediatric Population. J. Clin. Microbiol., 60.","DOI":"10.1128\/jcm.00292-22"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Taira, C.L., Okay, T.S., Delgado, A.F., Ceccon, M.E.J.R., de Almeida, M.T.G., and Del Negro, G.M.B. (2014). A Multiplex Nested PCR for the Detection and Identification of Candida Species in Blood Samples of Critically Ill Paediatric Patients. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-406"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Beardsley, J., Kim, H.Y., Dao, A., Kidd, S., Alastruey-Izquierdo, A., Sorrell, T.C., Tacconelli, E., Chakrabarti, A., Harrison, T.S., and Bongomin, F. (2024). 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. Med. Mycol., 62.","DOI":"10.1093\/mmy\/myae041"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"101082","DOI":"10.1016\/j.mycmed.2020.101082","article-title":"Antifungal susceptibility, species distribution and risk factors associated with mortality of invasive candidiasis in children in Turkey: A six-year retrospective, single-centre study","volume":"31","author":"Yakut","year":"2021","journal-title":"J. Med. Mycol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1080\/14787210.2025.2539427","article-title":"The changing epidemiology of Candida species in Asia Pacific and evidence for optimizing antifungal dosing in challenging clinical scenarios","volume":"23","author":"Chen","year":"2025","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","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":"ref_17","doi-asserted-by":"crossref","unstructured":"Ngamchokwathana, C., Chongtrakool, P., Waesamaae, A., and Chayakulkeeree, M. (2021). Risk Factors and Outcomes of Non-albicans Candida Bloodstream Infection in Patients with Candidemia at Siriraj Hospital-Thailand\u2019s Largest National Tertiary Referral Hospital. J. Fungi, 7.","DOI":"10.3390\/jof7040269"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chao, Q.T., Lee, T.F., Teng, S.H., Peng, L.Y., Chen, P.H., Teng, L.J., and Hsueh, P.R. (2014). Comparison of the Accuracy of Two Conventional Phenotypic Methods and Two MALDI-TOF MS Systems with That of DNA Sequencing Analysis for Correctly Identifying Clinically Encountered Yeasts. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0109376"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1111\/j.1469-0691.2010.03398.x","article-title":"Improved Clinical Laboratory Identification of Human Pathogenic Yeasts by Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry","volume":"17","author":"Bader","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Lee, H., Park, J.H., Oh, J., Cho, S., Koo, J., Park, I.C., Kim, J., Park, S., Choi, J.S., and Shin, S.Y. (2019). Evaluation of a New Matrix-Assisted Laser Desorption\/Ionization Time-of-Flight Mass Spectrometry System for the Identification of Yeast Isolation. J. Clin. Lab. Anal., 33.","DOI":"10.1002\/jcla.22685"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Keighley, C., Kim, H.Y., Kidd, S., Chen, S.C., Alastruey, A., Dao, A., Bongomin, F., Chiller, T., Wahyuningsih, R., and Forastiero, A. (2024). Candida tropicalis\u2014A systematic review to inform the World Health Organization of a fungal priority pathogens list. Med. Mycol., 62.","DOI":"10.1093\/mmy\/myae040"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Paul, S., Shaw, D., Joshi, H., Singh, S., Chakrabarti, A., Rudramurthy, S.M., and Ghosh, A.K. (2022). Mechanisms of Azole Antifungal Resistance in Clinical Isolates of Candida tropicalis. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0269721"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Leepattarakit, T., Tulyaprawat, O., and Ngamskulrungroj, P. (2022). The Risk Factors and Mechanisms of Azole Resistance of Candida tropicalis Blood Isolates in Thailand: A Retrospective Cohort Study. J. Fungi, 8.","DOI":"10.3390\/jof8100983"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1128\/AAC.03470-14","article-title":"Contribution of Clinically Derived Mutations in ERG11 to Azole Resistance in Candida albicans","volume":"59","author":"Flowers","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Whaley, S.G., Berkow, E.L., Rybak, J.M., Nishimoto, A.T., Barker, K.S., and Rogers, P.D. (2017). Azole Antifungal Resistance in Candida albicans and Emerging Non-albicans Candida Species. Front. Microbiol., 7.","DOI":"10.3389\/fmicb.2016.02173"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Szekely, J., Rakchang, W., Rattanaphan, P., and Kositpantawong, N. (2023). Fluconazole and echinocandin resistance of Candida species in invasive candidiasis at a university hospital during pre-COVID-19 and the COVID-19 outbreak. Epidemiol. Infect., 151.","DOI":"10.1017\/S0950268823001346"},{"key":"ref_27","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."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kimberlin, D.W., Banerjee, R., Barnett, E.D., Lynfield, R., and Sawyer, M.H. (2024). Candidiasis. Red Book: 2024\u20132027 Report of the Committee on Infectious Diseases, American Academy of Pediatrics. [33rd ed.].","DOI":"10.1542\/9781610027373"},{"key":"ref_29","unstructured":"Clinical and Laboratory Standards Institute (2022). Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data, Clinical and Laboratory Standards Institute. [5th ed.]. CLSI guideline M39."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Simner, P.J., Hindler, J.A., Bhowmick, T., Das, S., Johnson, J.K., Lubers, B.V., Redell, M.A., Stelling, J., and Erdman, S.M. (2022). What\u2019s New in Antibiograms? Updating CLSI M39 Guidance with Current Trends. J. Clin. Microbiol., 60.","DOI":"10.1128\/jcm.02210-21"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/INF.0b013e31826f547c","article-title":"Ocular manifestations of candidemia in children","volume":"32","author":"Fierro","year":"2013","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1093\/jpids\/piad057","article-title":"Adjunctive Diagnostic Studies Completed Following Detection of Candidemia in Children: Secondary Analysis of Observed Practice From a Multicenter Cohort Study Conducted by the Pediatric Fungal Network","volume":"12","author":"Wattier","year":"2023","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.ophtha.2021.07.015","article-title":"American Academy of Ophthalmology Recommendations on Screening for Endogenous Candida Endophthalmitis","volume":"129","author":"Breazzano","year":"2022","journal-title":"Ophthalmology"},{"key":"ref_34","first-page":"5960150","article-title":"Chronic Disseminated Candidiasis Complicated by Immune Reconstitution Inflammatory Syndrome in Child with Acute Lymphoblastic Leukemia","volume":"2016","author":"Ukielska","year":"2016","journal-title":"Case Rep. Hematol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Boussen, I., Lisan, Q., Raffoux, E., Di Blasi, R., Boissel, N., Oksenhendler, E., Ad\u00e8s, L., Xhaard, A., Bretagne, S., and Alanio, A. (2022). Hepatosplenic Candidiasis in Patients with Hematological Malignancies: A 13-Year Retrospective Cohort Study. Open Forum Infect. Dis., 9.","DOI":"10.1093\/ofid\/ofac088"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1186\/s13054-025-05527-z","article-title":"Screening, prevalence, and risk factors for secondary localization during candidemia in intensive care unit patients: The French CandidICU multicenter study","volume":"29","author":"Reizine","year":"2025","journal-title":"Crit. Care"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/12\/9\/664\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T04:50:44Z","timestamp":1788583844000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/12\/9\/664"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jof12090664"],"URL":"https:\/\/doi.org\/10.3390\/jof12090664","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]}}}