Community‐Onset Fungemias: Epidemiology and Genomic Characterization at a Tertiary‐Care Hospital in Barcelona, Spain
Open accessAbstract
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 (2004–2024). 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 63–82). 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.
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12 out of 59 (20.34%) descendant strains carry proved clinically significant FKS2 point mutations, including F659del, F659S, F659C, and S663F.
“12 out of 59 (20.34%) descendant strains carry proved clinically significant FKS2 point mutations, including F659del, F659S, F659C, and S663F [38, 39, 40].”
From Calcineurin‐Dependent Stress Adaptation Enables Caspofungin Heteroresistance Leading to Stable Resistance in <i>Candida Glabrata</i> (2026) · cites this paper as [39]
Table 3 (Discussion) identifies FKS2 F659C in one N. glabratus isolate and marks it as resistance-associated; Section 3.3 says that isolate was caspofungin-intermediate. The paper does not support the claimed 12 of 59 descendant strains or the additional FKS2 variants F659del, F659S, and S663F. (LLM, conf=0.90)
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The Silent Pandemic: Antifungal Resistance and the Future of Invasive Fungal Disease Management
Bagga, R., & Sridhar, K. K. (2026) · Microorganisms · doi:10.3390/microorganisms14030599 · Cited by 6 · see citing works
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- Authors
- Batista, C. S. P., Rivera, A., Alvarez Albarran, M. T., Rubio, M., Belen-Figas, I., Lopez-Querol, C., Miró, E., Navarro, F., & Sanchez-Reus, F.
- Affiliations
- Universitat Autònoma de Barcelona (ES)
- Emergency Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Hospital de Sant Pau (ES)
- Institut de Recerca Sant Pau (ES)
- Microbiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Genetics and Microbiology, Autonomous University of Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
- Corresponding author
- Batista, Celso Soares Pereira
- ORCID
- Venue
- Journal of Fungi
- Publisher
- MDPI AG
- Published
- 2025-11-14
- Volume
- 11
- Issue
- 11
- Pages
- 808
- ISSN
- 2309-608X (ISSN-L)
- OpenAlex
- W4416224512
- Cited by
- 2
- References
- 55
- Citations by year
- 2026: 2
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Fungi (publishedVersion, cc-by)
- Preprints.org (acceptedVersion, cc-by)
- PubMed (publishedVersion)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Keywords
- bloodstream infection, Candida glabrata, Candida albicans, Candida parapsilosis, Candida tropicalis, antifungal resistance, azole resistance, caspofungin resistance, nosocomial infections, co-infection
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