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Volume 11
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10.3390/jof11090630
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Article

Shifting Paradigms in Antifungal Prophylaxis and Their Effects on Candidemia Outcomes in Hematological Malignancies: A 14-Year Experience from a Single Tertiary Center

by
Fazıl Çağrı Hunutlu
1,*,
Fahir Özkalemkaş
1,
Beyza Ener
2,
Dilay Demirayak
3,
Büşra Çalışır
2,
Hikmet Öztop
4,
İbrahim Ethem Pınar
1,
Vildan Gürsoy
1,
Tuba Ersal
1,
Tuba Güllü Koca
5,
Emin Halis Akalın
6 and
Vildan Özkocaman
1
1
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, Gorukle Campus, Bursa 16059, Turkey
2
Department of Microbiology, Faculty of Medicine, Bursa Uludag University, Bursa 16059, Turkey
3
Department of Gastroenterology, Bilecik Education and Research Hospital, Bilecik 11000, Turkey
4
Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, Bursa 16059, Turkey
5
Department of Hematology, Bursa City Hospital, Bursa 16059, Turkey
6
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Bursa 16059, Turkey
*
Author to whom correspondence should be addressed.
J. Fungi 2025, 11(9), 630; https://doi.org/10.3390/jof11090630
Submission received: 2 August 2025 / Revised: 26 August 2025 / Accepted: 27 August 2025 / Published: 28 August 2025
Versions Notes

Abstract

Evolving antifungal prophylaxis approaches have reshaped candidemia patterns and outcomes in hematological malignancy (HM) patients. This study aimed to evaluate temporal changes in candidemia incidence, species distribution, and factors associated with mortality in relation to prophylaxis practices. Adult HM patients with candidemia between 2009 and 2023 were included. Clinical and microbiological data were analyzed, and candidemia rates were compared across different prophylaxis periods. Sixty-six patients were identified, with acute myeloid leukemia (AML) being the most common underlying malignancy (40.9%). Non-albicans Candida species predominated, especially C. krusei and C. tropicalis. In AML patients, candidemia incidence significantly decreased over time (β = −0.694, p = 0.004), with the lowest rates observed during the extended-release posaconazole tablet era (2016–2023). However, 30-day mortality remained high (53%) and unchanged across periods. Multivariate analysis identified C. tropicalis and total parenteral nutrition as independent risk factors for 30-day mortality (OR: 4.3 and 4.6, p < 0.05), while antifungal prophylaxis was protective (OR: 0.07, p = 0.017). In patients with AML, posaconazole prophylaxis, particularly in the extended-release tablet formulation, significantly reduced the incidence of candidemia. However, overall 30-day mortality rates remained high, with C. tropicalis being a major contributor. Thus, individualized prophylaxis and treatment strategies are crucial for improving outcomes.
Keywords: candidemia; antifungal prophylaxis; posaconazole; hematological malignancies; acute myeloid leukemia; Candida tropicalis candidemia; antifungal prophylaxis; posaconazole; hematological malignancies; acute myeloid leukemia; Candida tropicalis

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MDPI and ACS Style

Hunutlu, F.Ç.; Özkalemkaş, F.; Ener, B.; Demirayak, D.; Çalışır, B.; Öztop, H.; Pınar, İ.E.; Gürsoy, V.; Ersal, T.; Güllü Koca, T.; et al. Shifting Paradigms in Antifungal Prophylaxis and Their Effects on Candidemia Outcomes in Hematological Malignancies: A 14-Year Experience from a Single Tertiary Center. J. Fungi 2025, 11, 630. https://doi.org/10.3390/jof11090630

AMA Style

Hunutlu FÇ, Özkalemkaş F, Ener B, Demirayak D, Çalışır B, Öztop H, Pınar İE, Gürsoy V, Ersal T, Güllü Koca T, et al. Shifting Paradigms in Antifungal Prophylaxis and Their Effects on Candidemia Outcomes in Hematological Malignancies: A 14-Year Experience from a Single Tertiary Center. Journal of Fungi. 2025; 11(9):630. https://doi.org/10.3390/jof11090630

Chicago/Turabian Style

Hunutlu, Fazıl Çağrı, Fahir Özkalemkaş, Beyza Ener, Dilay Demirayak, Büşra Çalışır, Hikmet Öztop, İbrahim Ethem Pınar, Vildan Gürsoy, Tuba Ersal, Tuba Güllü Koca, and et al. 2025. "Shifting Paradigms in Antifungal Prophylaxis and Their Effects on Candidemia Outcomes in Hematological Malignancies: A 14-Year Experience from a Single Tertiary Center" Journal of Fungi 11, no. 9: 630. https://doi.org/10.3390/jof11090630

APA Style

Hunutlu, F. Ç., Özkalemkaş, F., Ener, B., Demirayak, D., Çalışır, B., Öztop, H., Pınar, İ. E., Gürsoy, V., Ersal, T., Güllü Koca, T., Akalın, E. H., & Özkocaman, V. (2025). Shifting Paradigms in Antifungal Prophylaxis and Their Effects on Candidemia Outcomes in Hematological Malignancies: A 14-Year Experience from a Single Tertiary Center. Journal of Fungi, 11(9), 630. https://doi.org/10.3390/jof11090630

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