Paradigm Shift: as the Most Prevalent Species Isolated from Bloodstream Infections with Increasing Azole-Non-Susceptibility Rates: Trends from 2015-2022 Survey.

Candidemia is the fourth most common healthcare-related bloodstream infection. In recent years, incidence rates of have been on the rise, with differences in prevalence and antifungal susceptibility between countries. The aim of the present study was to evaluate temporal changes in prevalence and antifungal susceptibility of among other species causing candidemia. All candidemia episodes from January 2015 to August 2022 were evaluated in order to depict time trends in prevalence of among all species recovered from blood cultures as well as fluconazole- and voriconazole-non-susceptibility rates. Secondary analyses evaluated time trends in prevalence and antifungal non-susceptibility according to clinical settings. The overall prevalence of was observed to increase compared to the prevalence of other species over time (-trend = 0.0124). From 2019, the number of isolates surpassed , without an increase in incidence rates. Overall rates of fluconazole- and voriconazole-non-susceptible were both 3/44 (6.8%) in 2015 and were 32/51 (62.7%) and 27/51 (52.9%), respectively, in 2022 (85% cross-non-susceptibility). The risk of detecting fluconazole- or voriconazole-non-susceptibility was found to be higher in compared to other species (odds ratio (OR) = 1.60, 95% CI [1.170, 2.188], -value < 0.0001 and OR = 12.867, 95% CI [6.934, 23.878], -value < 0.0001, respectively). This is the first study to report as the most prevalent among spp. isolated from blood cultures, with worrisome fluconazole- and voriconazole-non-susceptibility rates, unparalleled among European and North American geographical regions.