476c61dc87b9536ea95d43d79cf610d5 327678.pdf 023cf3fb85e8525501d9230ba45582cd99ccd22d 327678.pdf f639002e72c6be878075a697b64b7e4374d40c1916c8806bde44f2352d083344 327678.pdf Title: Community-Onset Fungemias: Epidemiology and Genomic Characterization at a Tertiary-Care Hospital in Barcelona, Spain Subject: 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. Keywords: community-onset fungemia; candidemia; Candida species; antifungal resistance; whole-genome sequencing Author: Celso Soares Pereira Batista, Alba Rivera, Maria Teresa Alvarez Albarran, Marc Rubio, Iris Belen-Figas, Cristina Lopez-Querol, Elisenda Miró, Ferran Navarro and Ferran Sanchez-Reus Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Fri Nov 14 07:06:58 2025 CET ModDate: Fri Nov 14 09:09:02 2025 CET Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 15 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 712658 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- JUSWWB+VnURWPalladioL Type 1 Custom yes yes yes 107 0 CFMMLO+URWPalladioL-Ital Type 1 Custom yes yes yes 108 0 BIJPUD+URWPalladioL-Bold Type 1 Custom yes yes yes 109 0 JORHOK+URWPalladioL-Roma Type 1 Custom yes yes yes 110 0 WIYEYL+CMSY10 Type 1 Builtin yes yes yes 149 0 CAMXTK+EURM10 Type 1 Builtin yes yes yes 172 0 URYLRZ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 206 0 AFDFGK+PalatinoLinotype TrueType WinAnsi yes yes no 216 0 AFDFFI+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 217 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-05-01 04:21:44 CEST RepresentationInformation: 327678.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-04-30 13:40:29 CEST Size: 712658 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 498 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Children: Item: Title: Clinical and Epidemiological Data Item: Title: Identification and Antifungal Susceptibility Item: Title: Molecular Analysis by Whole-Genome Sequencing (WGS) Children: Item: Title: DNA Extraction Item: Title: Next-Generation Sequencing (NGS) Item: Title: Bioinformatic Analysis Item: Title: Data Analysis Item: Title: Results Children: Item: Title: Epidemiology and Clinical Item: Title: Identification and Antifungal Susceptibility Test Item: Title: WGS Item: Title: Discussion Item: Title: References Info: Title: Community-Onset Fungemias: Epidemiology and Genomic Characterization at a Tertiary-Care Hospital in Barcelona, Spain Author: Celso Soares Pereira Batista, Alba Rivera, Maria Teresa Alvarez Albarran, Marc Rubio, Iris Belen-Figas, Cristina Lopez-Querol, Elisenda Miró, Ferran Navarro and Ferran Sanchez-Reus Subject: 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. Keywords: community-onset fungemia; candidemia; Candida species; antifungal resistance; whole-genome sequencing Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Fri Nov 14 07:06:58 CET 2025 ModDate: Fri Nov 14 09:09:02 CET 2025 ID: 0xc9caa7bf64912e16c1f9a91d2a6894b8, 0x32baebedc36e2e966af3113d024a5e24 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: WIYEYL+CMSY10 FontSubset: true FirstChar: 14 LastChar: 21 FontDescriptor: FontName: WIYEYL+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true ToUnicode: true Font: BaseFont: JUSWWB+VnURWPalladioL FontSubset: true FirstChar: 146 LastChar: 177 FontDescriptor: FontName: JUSWWB+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: CFMMLO+URWPalladioL-Ital FontSubset: true FirstChar: 2 LastChar: 122 FontDescriptor: FontName: CFMMLO+URWPalladioL-Ital Flags: Symbolic 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