Search Results (492)

Background: Candida isolation is common in critically ill patients, but its clinical interpretation depends strongly on microbiological source, host factors, and clinical context. Bloodstream isolation, candiduria, respiratory tract isolation, surveillance cultures, catheter-tip cultures, and wound/skin cultures have different clinical implications. We aimed to evaluate clinical characteristics, microbiological sources, species distribution, antifungal treatment patterns, and outcomes among adult ICU patients with Candida-positive ICU cultures. Methods: This single-center retrospective observational cohort study was conducted in the medical intensive care unit of Marmara University Faculty of Medicine between 1 October 2022 and 5 September 2025. Adult ICU patients with at least one Candida-positive ICU culture were included. Non-Candida fungal isolates and duplicate patient-level records were excluded. The primary outcome was all-cause 28-day mortality. ICU mortality was defined as all-cause death during ICU stay. Source-stratified analyses and expanded multivariable logistic regression models were performed to evaluate factors associated with mortality. Results: A total of 349 adult ICU patients were included. Median age was 71 years [IQR, 62–82], and 185 patients were male (53.0%). Overall, 28-day mortality was 59.0% (206/349), and ICU mortality was 65.9% (230/349). Candida colonization was identified in 247 patients (70.8%), whereas Candida infection was identified in 102 patients (29.2%). The most common species were Candida albicans (48.4%), Candida glabrata (13.8%), and Candida auris (12.9%). The most frequent microbiological sources were urine (42.4%), lower respiratory tract samples (26.4%), and blood cultures (14.9%). Blood/sterile-site isolation was associated with higher ICU mortality than non-blood/non-sterile-site isolation (79.2% vs. 63.5%, p = 0.026), whereas the difference in 28-day mortality was not statistically significant (66.0% vs. 57.8%, p = 0.260). Antifungal treatment was more frequent among patients with blood/sterile-site isolation (94.3% vs. 16.9%, p < 0.001). In the expanded 28-day mortality model, lactate, NLR, and carbapenem exposure were independently associated with mortality. In the expanded ICU mortality model, lactate and CRRT/hemodialysis were independently associated with mortality. Candida score was not independently associated with either 28-day mortality or ICU mortality after broader adjustment. Conclusions:Candida-positive ICU cultures represent a heterogeneous clinical and microbiological spectrum. Source-specific interpretation is essential, particularly when distinguishing bloodstream or sterile-site isolation from non-sterile-site colonization. Candida score may reflect a higher-risk clinical phenotype, but it should not be interpreted as a stand-alone mortality prediction tool. Full article

Background and Objectives: Candiduria is a common health problem especially among hospitalized patients. In the era of rising azole resistance, evidence from Saudi Arabia remains limited concerning Candida species. This study aimed to assess the prevalence and risk factors of Candida isolated from urine culture and to explore species distribution in relation to clinical characteristics. Materials and Methods: We retrospectively reviewed 188353 urine samples from 2013 to 2023. Using medical records, data on age, gender, hospitalization status, and urine sample type were collected. Identification of Candida species was performed by VITEK Mass Spectrometry (bioMerieux Inc.). Binary logistic regression analysis was used to identify predictors of candiduria. A p value below 0.05 at a 95% CI was considered statistically significant. Results: A total of 1667 urine samples with significant Candida growth were reported. It accounted for 0.88% of all organisms grown from urine culture and 30% of Candida grown from various body sites. Candida albicans was the most frequently identified species (n = 920, 55.2%), followed by C. tropicalis (n = 374, 22.4%), C. krusei (n = 80, 4.8%), C. glabrata (n = 78, 4.7%), and C. parapsilosis (n = 41, 2.5%). However, the rate was not stable throughout the years, and non-albicans Candida (NAC) was often the most prevalent. Female gender was the strongest predictor of candiduria (OR and AOR 1.81, 95% CI 1.46–2.25), whereas significantly lower odds were seen in elderly patients and in random urine specimens. The species distribution of NAC did not seem to change with age, gender, type of specimen, or hospitalization status. Conclusions: Among all Candida spp. isolated in the lab, 30 out of every 100 originated from urine culture, with a significant risk associated with females. The increasing prevalence of emerging Candida species in tertiary care settings can provide clinicians with valuable insights for the diagnosis and management of Candida UTI. Full article

Dracocephalum botryoides Stev. (Lamiaceae) is an endemic species of the Caucasus region with a history of traditional medicinal use, although the biological properties of its essential oil remain insufficiently characterized. In this study, the essential oil obtained from the aerial parts of D. botryoides collected in northern Azerbaijan was evaluated for its chemical composition, antioxidant, antimicrobial, antibiofilm, and cytotoxic activities. GC–MS analysis revealed a terpene-rich profile, with p-cymene (15.2%), T-cadinol (6.2%), caryophyllene oxide (6.0%), β-caryophyllene (5.8%), and sabinene (5.1%) as the major constituents. The essential oil showed notable antioxidant activity in DPPH and ABTS radical scavenging assays, with IC₅₀ values of approximately 60 and 63 µg/mL, respectively. The essential oil exhibited antimicrobial activity, with minimum inhibitory concentration (MIC) values of 0.2% (v/v) against Staphylococcus aureus ATCC 29213, Enterococcus faecalis ATCC 29212, and Candida albicans ATCC 10231. Higher MIC values were recorded for Escherichia coli ATCC 25922 and Candida glabrata ATCC 2001 (1.0% v/v), while the highest MIC value was observed for Trichophyton rubrum ATCC 28188 (2.5% v/v). The essential oil also inhibited biofilm formation, and scanning electron microscopy supported these findings by demonstrating reduced biofilm coverage and disrupted biofilm architecture. In vitro assays using HaCaT human keratinocytes indicated low cytotoxicity of the essential oil at concentrations below 100 µg/mL. These results suggest that the terpene-rich essential oil of D. botryoides possesses noteworthy antioxidant, antimicrobial, and antibiofilm potential. Full article

Increasing incidence of candidiasis and emergence of antifungal resistance necessitate the development of alternative antifungal strategies. In this context, the antifungal activity of the crude extract of Punica granatum L. peel (PGPE) and its chitosan nanoparticle-coated formulation (PGPE-CSNPs) was investigated against Candida albicans (ATCC 10231), Candida glabrata (ATCC 66032), Candida kefyr (ATCC 46764), Candida parapsilosis (ATCC 22019), and Candida tropicalis (ATCC 13803). Although the individual antimicrobial activities of PGPE and CSNPs have been investigated, their combined application against Candida spp. remains unexplored in the literature. The antifungal efficacy was evaluated using agar well diffusion, disk diffusion, minimum inhibitory concentration (MIC), and minimum fungicidal concentration (MFC) testing, and compared with fluconazole and amphotericin B. The morphological characterization of PGPE-CSNPs was performed using scanning electron microscopy (SEM), which confirmed successful encapsulation and revealed a smoother surface with uniformly distributed nanometric pore structures and reduced aggregation compared to uncoated CSNPs. PGPE-CSNPs showed greater inhibition zones than amphotericin B, except against C. albicans. The CSNPs formulation reduced the MIC from 8 µg/mL to 4 µg/mL and the MFC from 16 µg/mL to 8 µg/mL, representing a two-fold enhancement against C. albicans. No enhancement in activity was observed against C. glabrata, whereas for C. kefyr, only MFC values decreased from 8 µg/mL to 4 µg/mL. For both C. parapsilosis and C. tropicalis, MIC values reduced from 16 µg/mL to 8 µg/mL, and MFC values reduced from 32 µg/mL to 16 µg/mL for both species. PGPE-CSNPs exhibited significantly lower MIC and MFC values than the crude extract alone (p < 0.05). These findings suggest that chitosan-based nanocarriers may enhance the antifungal efficacy of plant-derived bioactive compounds, highlighting their potential as a promising alternative antifungal strategy, a combinatorial approach not previously reported in the literature. Full article

Background: Antifungal resistance among Candida species represents a growing clinical challenge, particularly in the context of increasing prevalence of non-albicans species. Methods: We conducted a retrospective analysis of 747 fungal isolates collected between 2021 and 2026, evaluating species distribution, antifungal susceptibility profiles, minimum inhibitory concentration (MIC) patterns, and temporal trends in resistance. Results: Non-albicans Candida species accounted for 67.5% of isolates, exceeding the proportion of Candida albicans. Fluconazole and flucytosine exhibited the highest resistance rates (16.1% and 17.4%, respectively), while amphotericin B showed the highest susceptibility rate (82.1%). MIC analysis revealed elevated MIC90 values for azoles in Candida glabrata and Candida krusei, consistent with reduced susceptibility. A significant association between antifungal agent and susceptibility profile was observed (χ² = 33.81, p < 0.001; Cramér’s V = 0.205). Temporal analysis demonstrated fluctuating resistance patterns rather than a consistent increase over time. Multidrug resistance was uncommon (2.5%), although non-susceptibility to multiple agents was more frequent (20.3%). Conclusions: The study highlights substantial variability in antifungal susceptibility across Candida species and antifungal agents, emphasizing the importance of continuous surveillance and species-specific treatment strategies. Full article

Objective: This study aimed to identify clinically modifiable and readily accessible predictors of 30-day mortality in a 10-year candidemia cohort and to assess temporal changes in Candida species distribution. Methods: We retrospectively evaluated 391 hospitalized adults with positive blood cultures for Candida spp. between January 2015 and March 2025. Only the first candidemia episode was included. Demographic characteristics, comorbidities, risk factors, laboratory parameters, antifungal therapy, and outcomes were recorded. Species identification was performed using conventional methods and the VITEK 2 system. Factors associated with 30-day mortality were analyzed using univariate and multivariate logistic regression models. Results: The mean age was 64.5 ± 17.7 years, and 56.3% of patients were male. Most patients (68.8%) were managed in the intensive care unit, and the 30-day mortality rate was 54%. Non-albicans Candida species accounted for 62.7% of isolates, with an increasing trend over time, particularly for Candida glabrata. Fluconazole susceptibility was 79%. In univariate analysis, advanced age, solid tumors, invasive mechanical ventilation, leukocytosis, thrombocytopenia, septic shock, intensive care unit admission, and failure to remove the central venous catheter were associated with mortality. Multivariate analysis identified advanced age, intensive care unit admission, septic shock, failure to remove the central venous catheter, leukocytosis, and thrombocytopenia as independent predictors of 30-day mortality. Conclusions: Candidemia remains a life-threatening infection with high mortality. Central venous catheter management and simple hematological parameters, particularly white blood cell and platelet counts, provide practical tools for early risk stratification. Although the rising prevalence of non-albicans Candida species may require updates in empirical therapy, prompt source control remains essential to improve survival. Full article

Background/Objectives: Fungal peritonitis is a severe complication of peritoneal dialysis (PD) associated with catheter removal, technique failure, and increased mortality. Although Candida albicans was traditionally the predominant pathogen, non-albicans Candida (NAC) species are increasingly reported. This review summarizes the epidemiology and outcomes of PD-associated NAC peritonitis. Methods: A systematic review was performed following PRISMA guidelines. PubMed/MEDLINE, Scopus, and Google Scholar were searched (January 1990–March 2026) for NAC peritonitis studies. Case reports and series with species-level identification were included. Results: 31 studies met the inclusion criteria, comprising 25 individual case reports and 6 case series, totaling 89 NAC isolates. Candida parapsilosis was the most frequently reported species (n = 50), followed by Candida tropicalis (n = 15). Other pathogens included Candida glabrata, Candida guilliermondii, and several rare NAC species. Fluconazole was the most commonly used initial antifungal therapy. Catheter removal was performed in most cases, with the majority of patients requiring transition to hemodialysis. Overall mortality was 20% among individual case reports vs. 24% across case series. Species-specific differences were observed: C. parapsilosis and C. guilliermondii were generally associated with favorable outcomes, whereas infections involving C. glabrata and other emerging NAC species more frequently required treatment escalation and were linked to poorer outcomes. Conclusions: NAC species are an important cause of fungal peritonitis in PD patients and show considerable heterogeneity in clinical outcomes and antifungal susceptibility. Early species-level identification and prompt catheter removal remain essential for optimal management. Full article

Vulvovaginal candidiasis (VVC) is a common gynecological infection, with Pichia kudriavzevii emerging as a significant pathogen due to its intrinsic fluconazole resistance and biofilm-forming capacity. This study investigates the antifungal efficacy and mechanisms of tannic acid (TA) against P. kudriavzevii, as well as its potential to reverse azole resistance across multiple Candida species with distinct resistance profiles. TA significantly inhibited P. kudriavzevii growth, surface colonization, and virulence gene expression at 3 μg/mL. Mechanistically, TA protected the human vaginal epithelial cell line VK2/E6E7 by reducing ROS levels, restoring mitochondrial membrane potential, and suppressing IL-1β and IL-18 release through modulation of the NLRP3-Caspase1-ASC axis. Furthermore, TA demonstrated synergistic activity when combined with azoles against five clinically azole-resistant Candida isolates spanning three Candida species with distinct resistance mechanisms: P. kudriavzevii (intrinsic), C. albicans (acquired), and N. glabrata (FKS-mediated). This study highlights TA as a promising natural therapeutic agent for P. kudriavzevii infections and offers a novel strategy for combating multidrug-resistant Candida through combination therapy. Full article

Candida species can shift from commensal organisms to opportunistic pathogens. Both Candida albicans and non-albicans Candida (NAC) species colonize oral biofilms and periodontal pockets, where they may contribute to inflammation and the progression of periodontal disease. This study aimed to determine the prevalence and antifungal susceptibility profiles of Candida species in individuals with different stages of periodontal disease. A cross-sectional study was conducted in 100 participants whose periodontal status was clinically evaluated. Saliva samples were cultured on chromogenic agar for yeast isolation, species identification was confirmed by MALDI-TOF MS, and antifungal susceptibility to fluconazole, clotrimazole, nystatin, and amphotericin B was assessed. Candida spp. was detected in 35% of participants, where C. albicans was the most prevalent species, followed by Nakaseomyces glabratus (formerly Candida glabrata), Candida parapsilosis, Candida dubliniensis, and Candida tropicalis. Species distribution varied according to periodontal status, with N. glabratus predominating in early periodontitis and C. albicans appeared more frequently in higher severe stages of periodontitis. Susceptibility testing showed resistance of C. albicans to clotrimazole (63.6%) and nystatin (22.7%), whereas amphotericin B and fluconazole remained effective. NAC species, particularly N. glabratus, exhibited resistance to nystatin and variable resistance to clotrimazole but remained susceptible to amphotericin B. These findings underscore the importance of early detection and personalized antifungal strategies for managing periodontal disease complicated by Candida colonization. Full article

Non-albicans Candida (NAC) species have emerged as significant opportunistic pathogens due to their reduced susceptibility to antifungal agents combined with their strong ability to form biofilms. The severity of systemic candidiasis caused by NAC species highlights the need for novel antifungal strategies. Retinoids, a group of compounds derived from vitamin A, have been demonstrated to possess significant antifungal activity against the reference strain C. albicans ATCC 2091. This study aimed to assess the antifungal potential of three retinoids, all-trans retinoic acid (ATRA), trifarotene, and tazarotene, against NAC clinical isolates. Various concentrations of the retinoids (from 1 mM to 0.06 mM) were tested in vitro against the growth, adhesion, and biofilm development of NAC species, including Candida glabrata, Candida krusei, and Candida tropicalis, as well as a reference strain of C. auris (CDC B11903). At 1 mM, all three compounds maximally inhibited the growth, adhesion, and biofilm formation of all tested NAC species. At lower concentrations (0.5–0.06 mM), C. krusei remained the most susceptible, especially to tazarotene. Tazarotene also showed a strong inhibitory effect on C. auris and C. glabrata at 0.5–0.25 mM; however, this effect was weaker than that observed against C. krusei. At low concentrations (0.12–0.06 mM), only trifarotene induced a mild but statistically significant inhibition of C. tropicalis growth. Trifarotene at 0.5 mM was also the most effective retinoid in inhibiting C. glabrata and C. tropicalis adherence and biofilm formation, with inhibitory activity maintained even at sub-0.5 mM concentrations (0.25–0.12 mM). Overall, the results suggest that all three retinoids exhibited dose-dependent and species-specific antifungal activity against NAC species, supporting their potential as novel, tailored antifungal agents against drug-resistant Candida strains. Full article

Invasive candidiasis (IC) remains a significant cause of morbidity and mortality among critically ill, hematologic, and neonatal patients worldwide. Rapid and accurate diagnosis is essential to guide timely antifungal therapy and improve outcomes. Among available diagnostic tools, 1,3-β-D-glucan (BDG), a polysaccharide component of the fungal cell wall, has emerged as a key biomarker. BDG assays allow for early detection of probable IC, often preceding positive blood cultures, and offer prognostic information based on serial measurements. Species-specific differences in Candida cell wall composition influence BDG release and diagnostic sensitivity. Candida albicans generally correlates with high BDG levels, whereas Nakaseomyces glabrata, Candida parapsilosis, and Candida auris exhibit variable or lower glucan exposure, limiting assay sensitivity. BDG performance is affected by patient-specific factors, such as prior surgery, transfusions, or coexisting bacterial infections, which may lead to false-positive results. Molecular techniques, including PCR-based assays, provide complementary diagnostic accuracy and species identification, and their combination with BDG testing enhances sensitivity up to 90%. Serial BDG monitoring supports risk stratification and treatment response assessment, with persistent elevations predicting worse outcomes. In neonatal and pediatric populations, optimal cut-off values remain under investigation, highlighting the need for integration with clinical and microbiological data. Overall, BDG represents a valuable adjunct in a multimodal diagnostic workflow, providing both diagnostic and prognostic insights in invasive candidiasis management. Full article

Background: The increasing antimicrobial resistance has led to a greater demand for alternative treatment options, which in turn has increased interest in naturally occurring biomolecules such as pyocyanin. Methods: In this study, a three-factor Box–Behnken Design (BBD)-based response surface methodology (RSM) was employed to optimize the effects of glycerol, peptone, and pH on pyocyanin production by Pseudomonas aeruginosa OG1. The antimicrobial efficacy of the optimized pyocyanin was subsequently evaluated in vitro against three Candida species and four clinically important bacterial pathogens using the disk diffusion method, with gentamicin and fluconazole used as positive controls. Results: The second-order polynomial model demonstrated excellent fit (F = 176.3, p < 0.0001) with a non-significant lack of fit, indicating adequate representation of the experimental data. The optimal conditions were determined to be glycerol at 1.11% (w/v), peptone at 17.86 g/L, and a pH of 7.27, yielding a predicted pyocyanin concentration of 25.92 mg/L. Antimicrobial testing revealed broad-spectrum, dose-dependent activity against all tested microorganisms. The highest efficacy was observed against Bacillus cereus (26.4 ± 1.3 mm at 40 µg/mL), followed by Candida glabrata (21.5 ± 1.6 mm), Klebsiella pneumoniae (17.6 ± 1.4 mm), Candida albicans (15.4 ± 1.8 mm), Candida parapsilosis (13.2 ± 1.9 mm), Proteus mirabilis (12.5 ± 1.3 mm), and MRSA Staphylococcus aureus (9.2 ± 1.1 mm). Conclusions: These findings demonstrate that BBD-based RSM is a robust approach for optimizing pyocyanin production and that pyocyanin represents a promising dose-dependent antimicrobial agent against susceptible pathogens. Full article

Candida fungi are among the most common human fungal pathogens and invasive candidiasis is one of the predominant invasive mycoses that mainly affects hospitalized patients with suppression of the immunological system and breaches in skin or mucosal barriers. Rapid diagnosis and implementation of appropriate antifungal treatment are key to achieving recovery. In recent years, attention has been drawn to the increasing significance of Candida species other than C. albicans, in particular C. auris and fluconazole-resistant C. parapsilosis. The aim of this work was to present the species spectrum and drug susceptibility of 570 Candida strains isolated from candidemia cases diagnosed in patients hospitalized in southern Poland in the period 2017–2022. The results of Candida-positive blood cultures obtained from five hospitals were analyzed. C. albicans was the most common species, accounting for 42.6% of all strains, followed by Nakaseomyces glabratus (formerly C. glabrata) and C. parapsilosis complex—22.1% and 18.8%, respectively. No C. auris was found. Fluconazole resistance was found in 4.9% of C. albicans strains, 34.7% of N. glabratus strains, and 8.7% of C. parapsilosis complex strains. Full article

The emergence of drug-resistant Candida species has intensified efforts to discover novel bioactive compounds. Antarctic environments harbor psychrophilic microorganisms that produce unique secondary metabolites adapted to extreme conditions, making them valuable natural resources for drug discovery. During the 2020 Antarctic Scientific Expedition, we collected 19 sediment samples from the South Shetland Islands and isolated 14 fungal strains belonging to Cladosporium, Oidiodendron, Penicillium, Pseudeurotium, and Pseudogymnoascus genera. Total organic extracts obtained from 21-day cultures were evaluated for antimicrobial activity against pathogenic yeasts and bacteria. Oidiodendron sp. (ECA57-20) and Pseudogymnoascus sp. (ECA57-61) demonstrated strong anti-Candida activity with minimum inhibitory concentrations ranging from 7.81 to 62.5 µg/mL against C. albicans, Pichia kudriavzevii (C. krusei), C. tropicalis, Nakaseomyces glabratus (C. glabrata), and Clavispora lusitaniae (C. lusitaniae). GC-MS (gas chromatography mass spectrometry) metabolomic profiling suggests a broad diversity of secondary metabolites across active strains, which may contribute to the observed biological activities. These findings support the potential of Antarctic fungi as sources of alternative antifungal agents. Full article

Brazil is home to one of the greatest biodiversities on the planet, with numerous plant species with unexplored pharmacological potential. In this study, the antifungal activity and cytotoxicity of crude extracts obtained from the seeds of Sterculia foetida L., Bulbostylis capillaris (L.) Kunth ex CB Clarke, and Pouteria caimito (Ruiz & Pav.) Radlk were investigated. The previously dehydrated seeds were subjected to extraction with physiological saline (saline extract), hexane (hexane extract) and sequential extraction with hexane followed by saline (hexane-saline extract). To determine antifungal activity via disk diffusion assays, broth microdilution based on the CLSI and evaluation of cellular specificity (EC₅₀) by redox metabolism with resazurin were performed on C. albicans ATCC 14053, C. albicans ATCC 24433 and non-albicans species Candida krusei ATCC 6258 and C. glabrata ATCC 22019. Cytotoxicity was evaluated in mouse bone marrow cells by determining the cytotoxic concentration (CC₅₀/24 h). The selectivity index (SI) was calculated as the ratio between CC₅₀ and EC₅₀. Statistical analysis of the data was performed via ANOVA, with the significance level set at p < 0.05. Saline, hexane, and hexane—saline extracts of S. foetida, as well as the saline extract of B. capillaris, showed selectivity indices higher than those of ketoconazole against C. albicans and C. krusei. With respect to C. glabrata, only the saline extract of B. capillaris demonstrated greater selectivity than the reference drug. All P. caimito extracts presented lower EC₅₀/24 h values than did ketoconazole but presented a low selectivity index, suggesting high cellular toxicity. The results obtained demonstrate that the crude extracts of S. foetida and B. capillaris seeds have significant antifungal activity and represent promising sources of bioactive compounds. Future studies should focus on the purification, isolation, and characterization of the active principles responsible for the observed activity. Full article