Medical mycology最新文献

{"title":"International Society for Human and Animal Mycology (ISHAM) One Health Sporotrichosis Working Group Proceedings - Bogota, Colombia, 2024 INFOCUS Conference.","authors":"Alyson M Cavanaugh, Amanda Ribeiro Dos Santos, Carolina Melchior Prado, Jose Pereira Brunelli, Pamela Thomson, Isabella Gremião, Dallas J Smith, Rodrigo Almeida-Paes, Regielly Caroline Raimundo Cognialli, Sandro Antonio Pereira, Eelco F J Meijer, Diego H Caceres, Nancy Chow, Shawn R Lockhart, Dayvison Francis Saraiva Freitas, Vanice Rodrigues Poester, Giovanni L Breda, Francelise Bridi Cavassin, Sandro Rogerio Almeida, Maria Adelaide Millington, Daniela Aguirre, Tom Chiller, Flavio Queiroz-Telles","doi":"10.1093/mmy/myaf101","DOIUrl":"https://doi.org/10.1093/mmy/myaf101","url":null,"abstract":"<p><p>Sporothrix brasiliensis, an emerging fungal threat, is spreading through South America with more than five countries in the Americas now reporting cases. Compared to other species, S. brasiliensis is more virulent and its primary transmission route to humans is from direct contact with infected cats. The increasing number of cases across South America and the challenges in preventing zoonotic transmission pose a significant and growing public health concern. On November 23, 2024, the International Society for Human and Animal Mycology One Health Sporotrichosis Working Group held a symposium to discuss current challenges and potential strategies. This article represents an overview of the discussions that occurred during the symposium focusing on four broad categories: identifying and monitoring introduction of S. brasiliensis in new regions; diagnosis; treatment of humans and cats; preventing and controlling the spread of S. brasiliensis. Overarching themes from all four categories included a gap in the scientific understanding needed to effectively guide public health action and clinical care and the need for multidisciplinary collaboration to address the problem. A better understanding of the epidemiology, including transmission, and optimal diagnostics and clinical treatments are needed. Public health activities with a One Health approach, including surveillance, health education, prevention, and control efforts may benefit from innovative strategies that involve microbiologists, veterinarians, physicians, and public health officials.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expansion of a predominant azole-resistant Candida tropicalis genotype from 2012 to 2018: evidence from orchard environments in Taiwan.","authors":"Yin-Zhi Chen, Kuo-Yun Tseng, Min-Nan Tseng, Jyh-Nong Tsai, Ching-Ching Hsu, Yu-Chieh Liao, Chih-Chao Lin, De-Jiun Tsai, Feng-Jui Chen, Li-Yun Hsieh, Chiao-Mei Lin, Chi-Jung Wu, Huey-Kang Sytwu, Hsiu-Jung Lo","doi":"10.1093/mmy/myaf098","DOIUrl":"https://doi.org/10.1093/mmy/myaf098","url":null,"abstract":"<p><p>A predominant fluconazole-resistant Candida tropicalis clade 4 genotype, based on MLST analysis, causing candidemia in humans in several tropical countries was detected in the environment in a 2012 orchard survey in Taiwan, which is an emerging one health issue. This follow-up study investigated clade 4 azole-resistant C. tropicalis in orchards, comparing the 2012 survey data with the 2018 survey findings. We compared C. tropicalis isolated from the same 53 orchards, including 23 wax apple, 17 grape, and 13 papaya orchards, in both the 2012 and 2018 surveys. We collected samples of fruits, soils, and irrigation water from environment and swab samples from armpit and hand, as well as oral mouth rinses of the farmers. Overall, the rate of fluconazole-resistant C. tropicalis from the 2018 survey was significantly higher than that from the 2012 survey (27/55 vs. 9/46, p = 0.003). Furthermore, we found that the use of azole fungicides was associated with the detection of azole-resistant C. tropicalis. Notably, 77.8% (7/9) of the azole-resistant isolates in the 2012 survey and 92.6% (25/27) in the 2018 survey were genetically related and belonged to the clade 4 genotype. Our findings demonstrate that the rate of fluconazole-resistant C. tropicalis from orchards increased significantly and the clade 4 drug-resistant C. tropicalis spread widely in orchard environments, especially among grape ones. Our findings show that different types of crop had different cultivation habits. Hence, grape orchard environment is a priority to conduct intervention for cultivation habits of farmers, especially on azole fungicide use in Taiwan.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular diversity of Enterocytozoon bieneusi (microsporidia) among children, adolescents and young women in poor-resource settings in southern Madagascar.","authors":"Gabriela Tapia-Veloz, Alejandro Dashti, Pamela C Köster, Mónica Gozalbo, Màrius Vicent Fuentes, David Carmena, Sergio Sánchez, María Trelis","doi":"10.1093/mmy/myaf099","DOIUrl":"https://doi.org/10.1093/mmy/myaf099","url":null,"abstract":"<p><p>Microsporidia are obligate intracellular eukaryotic parasites, phylogenetically related to fungi, and are recognised causes of significant morbidity in humans. They are opportunistic pathogens of particular concern in HIV-infected and other immunocompromised populations. In this study, the occurrence and genetic diversity of microsporidian infections (Enterocytozoon bieneusi and Encephalitozoon spp.) were investigated in socially vulnerable populations from disadvantaged areas in southern Madagascar. Epidemiological questionnaires were used to collect demographic data and potential risk factors. Faecal samples (n = 436) from 318 children and adolescents (7-21 years), 57 young mothers (16-21 years), and 61 of their infants (0-5 years) were collected and analysed using molecular methods (PCR and Sanger sequencing). Only E. bieneusi infections were detected, with an overall prevalence of 3.0% (95% CI: 1.6-5.0). The highest prevalence was observed in young mothers (3.5%; 95% CI: 0.4-12.1), nearly followed by infants (3.3%; 95% CI: 0.4-11.4). Genotyping of E. bieneusi was successfully performed in 11 of the 13 positive samples, identifying five known genotypes (A, CAF1, D, PigEBITS7, and Type IV) and one novel genotype, designated HhMdEb1. The most frequently detected genotypes were A and CAF1. All genotypes identified, including the novel genotype, belong to Group 1, which is characterised by low host specificity and high zoonotic potential. The detection of genotypes commonly associated with animal hosts suggests both zoonotic and anthroponotic transmission pathways. These findings underscore the need to implement integrated control strategies within the framework of the 'One Health' approach.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance comparison of mold identification by Bruker and Vitek MALDI-TOF mass spectrometry.","authors":"Heather L Glasgow, Ginger R Jamison, Rosalie Perkins, Carolyn Hewitt, Warda Memon, Randall T Hayden, Sean X Zhang","doi":"10.1093/mmy/myaf096","DOIUrl":"https://doi.org/10.1093/mmy/myaf096","url":null,"abstract":"<p><p>Filamentous fungal, or mold, infections are a major cause of morbidity and mortality in immunocompromised patients, requiring rapid and accurate identification for appropriate clinical management. Conventional culture-based identification of molds may require long culture times and careful gross and microscopic morphologic identification by highly experienced technologists. However, MALDI-TOF MS has shown promise for faster identification of cultured molds. We compared the agreement of Bruker MALDI Biotyper Filamentous Fungi Library 4.0 identification with VITEK MS Knowledgebase Library 3.2 identification of 149 mold culture isolates collected for routine patient care from two hospitals, comprising 35 species or species-complexes. Sequencing and/or culture morphology were used to identify molds that were discordantly identified by the two platforms. Sequencing was performed on all Fusarium species isolates, which cannot be differentiated morphologically. All isolates were concordantly identified by the two MALDI-TOF MS systems at the genus level except for one isolate (99%). Species-level concordance between the two systems was achieved at 81% (120/149). Five (9.8%) isolates of Fusarium species were concordantly identified by the MALDI-TOF MS systems but identified as a different species or species-complex by gene sequencing. Three fungal species considered concordantly identified by MALDI-TOF MS systems exhibited nomenclatural inconsistencies. Although their databases and methods differ, current VITEK and Bruker MALDI-TOF MS systems have high concordance for identification of most common molds isolated in clinical microbiologic laboratories, but users should be aware of performance limitations and nomenclature differences.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning for the Identification of Candida spp. Directly from Blood Culture Gram Stains from Candidemia Patients.","authors":"Juan Carlos Cuevas-Tello, Azael Monreal-de la Rosa, Juan Luis Quistian-Navarro, Areli Martinez-Gamboa, Maria Fernanda González-Lara, Norma Irene López-García, Andrea Rangel-Cordero, Luis Esau López-Jacome, Mercedes Isabel Cervantes-Hernandez, Rafael Franco-Cendejas, Juan Carlos Muñoz-Escalante, Daniel E Noyola, Pedro Torres-González","doi":"10.1093/mmy/myaf097","DOIUrl":"https://doi.org/10.1093/mmy/myaf097","url":null,"abstract":"<p><p>Candidemias caused by the yeasts formerly encompassed as Candida spp. require expedited identification to decide on the antifungal treatment and reduce mortality. Traditional methods rely on subcultures for diagnosis, with turnaround times of 72-96 hours, or expensive equipment. Deep Learning and convolutional neural networks (CNN) have shown high accuracy for image recognition in microbiology. We compared the accuracy of six CNN (GoogLeNet, InceptionV3, AlexNet, ResNet18, ResNet50, and DenseNet161) to identify Candida spp. at the species level, with photographs obtained mainly from clinical blood cultures showing yeast structures in the Gram stain, which were identified as Candida spp. in the subculture. Images were obtained from January 2012 to May 2024 and stored in the image databank of two third-level teaching hospitals in Mexico City. We analyzed the five most frequent species from both centers' clinical samples and included simulated blood culture images from Candida auris (Candidozyma auris) and Candida krusei (Pichia kudriavzevii) strains. After processing and segmentation, we loaded the CNNs with 531 whole photographs and 2804 patches. The CNN Densnet161, using a scan-based approach, showed higher accuracy identifying 87%, 99%, 94%, 100%, 89%, and 95% of the images containing Candida albicans, C. auris, C. glabrata (Nakaseomyces glabrata), C. krusei (P. kudriavzevii), C. parapsilosis, and C. tropicalis, respectively. These results show that CNN image recognition can identify clinically relevant Candida spp. directly from positive Gram-stained smears, which may help make early decisions for antifungal treatment.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of the Novel Mitochondrial Targeted Compound Phosundoxin against Sporothrix globosa: Microbial Sensitivity Test combined with Transcriptomics and Proteomics.","authors":"Hanyue Sheng, Shu Zhang, Wenjing Zhu, Tiantian Chen, Yuanyuan Geng, Xiaonan Guo, Fei Zhao, Zhaohai Qin, Shuang Wang, Jie Gong","doi":"10.1093/mmy/myaf095","DOIUrl":"https://doi.org/10.1093/mmy/myaf095","url":null,"abstract":"<p><p>In recent years, the resistance of Sporothrix globosa to antifungal treatments has steadily increased, while the cure rate for sporotrichosis has declined. This growing resistance underscores the urgent need to develop novel antifungal agents with distinct mechanisms of action. Previous studies have demonstrated that phosundoxin, a biphenyl aliphatic amide that targets mitochondria, exhibits potent inhibitory effects against a broad spectrum of fungi. To further evaluate its antifungal activity, we conducted drug susceptibility testing on 112 S. globosa strains and compared the results with those of conventional antifungal agents. Phosundoxin consistently exhibited antifungal activity against all tested strains, including both mycelial forms and 32 yeast-phase strains, at concentrations ranging from 1 to 4 µg/mL. Notably, in itraconazole-resistant S. globosa strains, phosundoxin treatment led to the identification of 553 differentially expressed genes (DEGs) and 273 differentially expressed proteins (DEPs). Integrated Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses revealed that phosundoxin exerts its antifungal effects by disrupting the mitochondrial respiratory chain and oxidative phosphorylation. This disruption triggers cellular stress responses, including the upregulation of ammonia transport and nitrogen metabolism. Additionally, phosundoxin treatment weakens cellular defense mechanisms, interferes with the cell cycle, and inhibits protein synthesis-ultimately leading to negative regulatory effects and cell death. These findings highlight phosundoxin's potential as a novel antifungal agent for treating S. globosa infections and provide critical insights into its mechanism of action against this pathogen.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cat claws as a possible reservoir of Sporothrix brasiliensis in Magallanes, Chile.","authors":"Pamela Thomson, Ailén Dumont-Viollaz, Amanda Ribeiro Dos Santos, Leslye Camila Del Río, Olivia Blank, Valentina Ramírez","doi":"10.1093/mmy/myaf094","DOIUrl":"https://doi.org/10.1093/mmy/myaf094","url":null,"abstract":"<p><p>Cats attended at veterinary clinic, in Magallanes, Chile, were screened for Sporothrix brasiliensis in their claws. Five of 140 screened cats were positive, with three of them being symptomatic. Increased awareness of S. brasiliensis circulating in Chile could help take precautions to prevent feline outbreaks and human infection.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virulence Assessment of Sporothrix Species from Clinical and Environmental Clades Using Tenebrio molitor as an Experimental Model.","authors":"Georggia Fátima Silva Naliato, Thales Domingos Arantes, Anderson Messias Rodrigues, Patrícia Pimentel, Katia Scorteci, Gisleine França, Maria Lúcia Cordeiro, Raquel Cordeiro Theodoro","doi":"10.1093/mmy/myaf092","DOIUrl":"https://doi.org/10.1093/mmy/myaf092","url":null,"abstract":"<p><p>Sporotrichosis is a neglected subcutaneous mycosis, globally distributed, caused by thermal dimorphic Sporothrix species. Despite their pathogenic potential in vertebrates, the virulence mechanisms underlying the interaction of these fungi with other groups of organisms remain poorly understood. The present study utilized the coleopteran insect Tenebrio molitor as an experimental model to assess the virulence of seven Sporothrix species belonging to the clinical (Sporothrix brasiliensis, Sporothrix schenckii, Sporothrix globosa, and Sporothrix luriei) and environmental (Sporothrix pallida, Sporothrix mexicana, and Sporothrix chilensis) clades. Larvae were inoculated with conidia or yeast cells and evaluated for survival, fungal burden (colony forming units), histopathology, hemocyte count, and expression of antimicrobial peptide genes. The virulence patterns in this model mirrored those observed in mammalian models for Sporothrix species from the clinical clade, with S. schenckii and S. brasiliensis exhibiting higher virulence (larvae survival rate 30-40%). Furthermore, the study revealed distinct virulence profiles between the mycelial and yeast phases of the fungi, with the yeast phase generally associated with increased virulence. However, contradicting previous findings, in the murine model, the environmental clade species S. pallida and S. chilensis displayed unexpectedly high virulence in their mycelial phase in T. molitor (larvae survival rate of 30% and 10% respectively). Also, the expression profile of AMP genes (Thamatin-like 1 and Tenecin 3) was similarly higher for those larvae infected with S. brasiliensis and S. pallida. These results indicate that the immune response to Sporothrix species in this invertebrate model may also have been shaped by the natural history of coleopteran insects and the Sporothrix genus. Our study highlighted the complex interplay between fungal virulence, host immune response, and ecological factors in shaping the outcome of Sporothrix infections in T. molitor.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Caspofungin for the Treatment of Candidemia in critically ill patients with obesity: A Multicenter Retrospective Cohort Study.","authors":"Aisha Alharbi, Khalid Al Sulaiman, Nader Damfu, Shuroug A Alowais, Sultan Alotaibi, Yazed Saleh Alsowaida, Manal A Aljohani, Nisrin Bifari, Fahad Alshammari, Mohammed Asiri, Imtinan A Almasoudi, Marwah Almuzaini, Ashwaq F Alqurashi, Seba K Alobathani, Entisar J Almodyan, Reem Almutairy, Maha Aldhafeeri, Raghad A Alshehri, Safiah Sowaid Alghamdi, Alhammad A Mohamed, Atheer Mohammad Aljuhani, Norah Alandas, Samar Alotaibi, Ohoud Aljuhani","doi":"10.1093/mmy/myaf093","DOIUrl":"https://doi.org/10.1093/mmy/myaf093","url":null,"abstract":"<p><p>In critically ill patients, obesity frequently results in changes to caspofungin pharmacokinetic parameters. Given the limited evidence available regarding the optimal dosing strategy for critically ill patients with obesity and candidemia, this study aims to evaluate the clinical outcomes of caspofungin standard dose in critically ill patients with obesity and confirmed candidemia. A multicenter, retrospective cohort study was conducted in three tertiary care hospitals in Saudi Arabia. Eligible critically ill patients with confirmed candidemia who received standard dose of caspofungin were stratified according to their Body Mass Index (BMI) at the time of caspofungin initiation into two groups: control (whose BMI was 18 - 29.9 kg/m2) or obese (whose BMI≥ 30 kg/m2). The primary outcome was the incidence of clinical success. All other outcomes were considered secondary. The significance level was set at p-value < 0.05 and statistical analysis was conducted using SAS 9.4 software. A total of 108 patients were included, 46 (42.6%) of whom were obese. There were no statistically significant differences in terms of clinical success between the groups (OR 1.38 (0.54, 3.54), p-value = 0.50). The microbiological success rate was numerically lower in the obese group (69.6% vs 83.9%; p-value = 0.07), notably, the difference was statistically significant in regression analysis (OR 3.40; p-value = 0.04; 95% CI, 1.040, 11.099). No significant differences were observed in all other outcomes including time for clinical success, time for microbiological success, clinical failure, infection recurrence within 90 days, in-hospital mortality, 30-day mortality, hospital and ICU length of stay. In terms of safety outcomes, both groups had a comparable incidence rate of adverse drug reactions. Our study revealed that patients with obesity had similar clinical success to non-obese patients. However, the microbiological success rate was lower in patients with obesity who received caspofungin standard dose. Further research is needed to validate these results and explore the long-term implications of caspofungin therapy in obese patients with candidemia.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of direct antifungal susceptibility testing using E-test for four antifungal agents in candidemia patients.","authors":"Grégoire Miaux, Ryane Benkhelil, Gisèle Dewulf, Séverine Loridant, Eric Dannaoui, Edith Mazars","doi":"10.1093/mmy/myaf077","DOIUrl":"10.1093/mmy/myaf077","url":null,"abstract":"<p><p>Candidemia is associated with high morbidity and mortality. Delayed initiation of effective and appropriate antifungal therapy correlates with increased patient mortality, emphasizing the importance of rapid antifungal susceptibility testing (AFST). Usual commercial methods, such as the standard E-test, are time-consuming, often requiring a minimum of 48 h. This study aimed to evaluate the performance of direct E-test (ET-dir) directly from positive blood culture bottles, with the goal of reducing turnaround time and improving clinical decision-making. A total of 160 yeast positive blood cultures were included over a 4-year period, comprising 85 Candida albicans. The minimum inhibitory concentrations (MICs) of fluconazole, voriconazole, amphotericin B, and anidulafungin were determined using ET-dir and compared to ET method (ET-sd). Essential agreement, categorical agreement, error rates, and bias were analyzed for all species and specifically for C. albicans. The essential agreement between ET-dir and ET-sd exceeded 87% for all antifungal agents and reached ≥90% for fluconazole. The categorical agreement was above 90% for all agents, and error rates remained within acceptable limits except for anidulafungin. For C. albicans, 23 of 24 performance data met acceptability criteria, with essential agreement ≥90% for all agents except fluconazole. ET-dir results were interpretable within 24 h for 93.7% of strains, providing at least a 24-h time gain over ET-sd. ET-dir is a reliable and rapid AFST method for candidemia, meeting most performance criteria compared to ET-sd while significantly reducing turnaround time. Its routine implementation could enable faster adaptation of antifungal therapy, ensuring that treatments are optimized based on susceptibility results.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144961052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}