Search Results (349)

Digestive candidiasis is a major opportunistic infection among people living with HIV (PLHIV). In Gabon, data on antifungal resistance remain limited. This study aimed to characterise Candida colonisation and antifungal resistance according to anatomical site and species in Libreville. In this cross-sectional study, 108 PLHIV provided paired oral and stool samples. Candida spp. was identified using conventional phenotypic methods. Antifungal susceptibility to azoles and polyenes was assessed by disc diffusion following CLSI guidelines. Resistance burden was classified by drug class and by cumulative number of antifungal agents involved. Digestive colonisation was detected in 97 (89.8%) participants. Oral and intestinal colonisation rates were 78.7% and 66.7%, respectively, with dual-site involvement in 55.6%. Among resistant isolates, Candida albicans accounted for 55.2% (oral) and 48.9% (intestinal), while non-albicans Candida represented 29.8% and 44.4%, respectively. Multidrug resistance was significantly higher in intestinal than oral isolates (36.2% vs. 11.8%; OR = 4.99; 95% CI: 2.04–12.16; p < 0.01). Resistance was predominantly azole-driven, with complex cumulative resistance profiles in intestinal isolates. The intestinal tract showed resistance profiles consistent with a preferential accumulation of MDR Candida populations in PLHIV. Site-specific resistance patterns underscore the importance of targeted sampling and antifungal stewardship strategies in resource-limited settings. Full article

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/Objectives: Skin candidiasis is a key contributor to chronic, non-healing wounds, largely due to persistent microbial infections. Candida species can colonize the skin, form protective biofilms, and interfere with enzyme activity, leading to extracellular matrix degradation, changes in pigmentation, and impaired wound healing. The rising prevalence of antifungal resistance challenges its management, underscoring the need for more effective antifungal therapies. Therefore, this study aimed to assess the antifungal effects and wound-healing potential of essential oils (EOs) from Ferulago spp. Methods: The antifungal activity of the EOs from five Ferulago species was evaluated against Candida spp. and Cryptococcus neoformans. The most active EOs were further investigated for their effects on C. albicans virulence factors, including germ tube formation, as well as biofilm formation and disruption. These effects were assessed using microscopic observation, XTT reduction assay, and crystal violet and safranin stainings. The wound-healing potential of the EOs was evaluated using the scratch-wound assay on fibroblasts and keratinocytes. Additionally, the effect on tyrosinase and elastase activity, was also investigated. Results:F. silaifolia and F. cassia essential oils showed fungicidal activity against Candida spp. and Cryptococcus neoformans. F. silaifolia displayed greater potency, with lower MIC and MLC values. Both oils inhibited key C. albicans virulence factors at sub-MIC concentrations. F. silaifolia EO was more effective in preventing biofilm formation whereas F. cassia EO showed notable tyrosinase inhibitory effect. Conclusions: These findings align with traditional uses and suggest that F. silaifolia and F. cassia EOs exhibit antifungal activity alongside properties associated with wound healing, supporting their potential as topical antifungal agents and thereby justifying further investigation. 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

Background and Objectives: The epidemiological characteristics of Candida species have changed worldwide, with an increasing number of reports on co-infections with non-albicans Candida species (NACs) and multidrug-resistant bacteria. A longer length of hospital stay, more severely ill patients, and empirical antimicrobial use in intensive care units (ICUs) increased the prevalence of Candida healthcare-associated infections (HAIs). If the diagnosis or treatment of invasive candidiasis is delayed, the morbidity and mortality of patients will significantly increase. Materials and Methods: We conducted a nationwide surveillance study to analyze data on HAIs in the ICUs of medical centers and regional hospitals between 2018 and 2023. We assessed the temporal trends of Candida species (including Candida albicans and NACs) across all HAIs, bloodstream infections (BSIs), and urinary tract infections (UTIs), and simultaneously assessed the corresponding trends of Enterococcus faecium (Efm). A linear trend for the proportions of microorganisms from 2018 to 2023 was noted according to the Mantel–Haenszel chi-square test. Spearman’s rank correlation coefficients were used to analyze the correlations between pathogen proportions, systemic antimicrobial agent consumption, and length of ICU stay. Results: The overall proportion of all Candida species in HAIs in the ICUs increased significantly from 15.13% to 16.74% (p < 0.001); this increase was driven mainly by NACs (increasing from 6.84% to 7.91%, p < 0.001) from 2018 to 2023. The proportion of Efm increased significantly, from 7.7% to 11.11% (p < 0.001). The proportions of all Candida species significantly increased in UTIs (from 24.63% to 28.13%, p < 0.001), especially NACs, while the proportion of Efm also increased significantly in UTIs (from 9.47% to 15.32%, p < 0.001). With respect to the UTIs, the proportion of all the Candida species, C.albicans, and NACs were positively correlated with the amount of systemic antibiotics used. A longer hospital stay was strongly correlated with all Candida HAIs and UTIs, especially NACs. Significantly ecological associations between all the Candida strains and Efm were observed for UTIs. Conclusions: This study revealed that a persistent expansion of NAC infections was associated with increased Efm infections and rising antibiotic consumption. The changes in the proportions of different Candida species in UTIs were most pronounced. These findings support an ecological model in which antibiotic stress and chronic critical illness contribute to the expansion of fungal–bacterial co-infections in the ICU setting and underscore the need for integrated antibiotic management and multi-infection surveillance. Full article

Breakthrough invasive fungal infections (bIFIs) are a challenging serious complication in high-risk hematologic patients and allogeneic hematopoietic stem cell transplantation recipients that may negatively impact their outcome. Despite advances in antifungal prophylaxis, diagnostics, and supportive care, bIFI occurrence reflects a complex interaction between host immunosuppression, emergence of resistant pathogens and pharmacological variables, including subtherapeutic drug exposure. Candida spp. have shifted towards non-albicans yeasts, whereas breakthrough mold infections more frequently involve non-fumigatus Aspergillus, Mucorales, Fusarium spp., and Scedosporium/Lomentospora spp. Early clinical recognition, rapid therapy escalation, aggressive diagnostic investigation, a switch to liposomal amphotericin B-based regimens in patients on azole prophylaxis, and therapeutic drug monitoring are essential to improve outcomes. Reducing the growing global burden of bIFIs will also require improved access to high-quality diagnostics and strengthened educational and stewardship efforts that prioritize antifungal resistance as an urgent health concern. Full article

Candida dubliniensis is an opportunistic yeast closely related to Candida albicans and an uncommon cause of central nervous system (CNS) infection. While isolates are often susceptible to azoles, reduced susceptibility or acquired resistance may occur, making species identification and antifungal susceptibility testing clinically relevant. We report a 3-year-old boy with Philadelphia chromosome-positive B-cell precursor acute lymphoblastic leukemia (ALL) in hematologic remission who developed chronic meningitis during maintenance chemotherapy. The initial presentation was non-specific (marked somnolence without fever or meningeal signs) and lumbar puncture performed to exclude CNS relapse revealed neutrophil-predominant pleocytosis and elevated protein; the cerebrospinal fluid (CSF) culture grew C. dubliniensis. Treatment with intravenous liposomal amphotericin B followed by prolonged fluconazole led to clinical improvement and sterile CSF. Six months later, progressive gait disturbance, limb pain, and episodic severe headaches recurred; repeat CSF cultures again yielded C. dubliniensis, with a changed susceptibility profile. Spine MRI demonstrated leptomeningeal enhancement involving the cauda equina nerve roots. Intravenous voriconazole with therapeutic drug monitoring was initiated and combined with intrathecal liposomal amphotericin B (seven doses, dose-escalated up to 3 mg), which was well tolerated and associated with rapid neurologic improvement, CSF sterilization, and radiologic resolution. At 12 months of follow-up, the patient remained infection-free and in leukemia remission. This case highlights that C. dubliniensis chronic meningitis may present subtly yet progress, requiring repeated CSF cultures with susceptibility testing; intrathecal liposomal amphotericin B can be a safe and effective adjunct to systemic therapy in refractory or recurrent disease. Full article

Background/Objectives: Fungal keratitis remains a vision-threatening infection, and current amphotericin B (AmphB) eye drops suffer from low corneal residence time, poor aqueous solubility, and the need for frequent dosing. This study develops electrospun nanofiber-based ophthalmic inserts combining polyvinyl alcohol (PVA), gamma-cyclodextrin (γ-CD), and sodium taurocholate (STC) to enhance AmphB solubility and provide a non-invasive, rapidly dissolving ophthalmic dosage form. Methods: γ-CD and STC-enhanced AmphB-loaded PVA nanofiber-based ophthalmic inserts with varying γ-CD and STC concentrations were prepared by electrospinning and characterized by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD). Drug content, in vitro release (Weibull modeling), antifungal activity against Candida albicans, Fusarium solani, and Aspergillus fumigatus, ocular cytocompatibility using the Hen’s Egg Test on Chorioallantoic Membrane (HET-CAM), and accelerated stability (40 ± 2 °C, 75 ± 5% relative humidity, 4 weeks) were evaluated. Results: Bead-free nanofibers with mean diameters between 216 ± 33 nm and 310 ± 35 nm were obtained, and XRD confirmed complete amorphization of AmphB within the PVA nanofiber matrix, forming an amorphous solid dispersion. All formulations showed rapid and nearly complete AmphB release (≈100% within 60 min), with Weibull β values < 0.75, indicating Fickian diffusion-controlled release. AmphB-loaded PVA nanofiber-based ophthalmic inserts produced inhibition zones and broth susceptibility profiles comparable to AmphB in dimethyl sulfoxide (DMSO), demonstrating preserved antifungal activity. HET-CAM scores (0–0.9) classified the inserts as practically non-irritant, and SEM/FTIR after accelerated storage showed no relevant morphological or physicochemical changes. Conclusions: These γ-CD and STC-enhanced AmphB-loaded PVA nanofiber-based ophthalmic inserts provide a non-invasive, rapidly dissolving ophthalmic dosage form that combines amorphous AmphB, immediate drug availability, and good ocular tolerance, supporting their further development as a patient-friendly treatment option for fungal keratitis. Full article

Ocular fungal diseases are associated with severe infection and pain and, in advanced stages, can lead to vision loss. Current treatment options are limited to the topical application of conventional drugs, and the bioavailability of these drugs is quite limited due to ocular barriers. In this study, a dual-drug nanodelivery system was developed to improve intraocular drug delivery by combining antifungal and anti-inflammatory therapies. Posaconazole (PSC), a broad-spectrum triazole antifungal agent, and dexketoprofen trometamol (DKP), a rapidly acting nonsteroidal anti-inflammatory drug, were co-loaded onto polymeric micelles and then incorporated into electrospun poly(vinyl alcohol)/poly(vinylpyrrolidone) (PVA/PVP) nanofiber intraocular implants. DSC, XRD, FTIR, and FESEM analyses showed that both APIs were successfully converted into nanofiber form without disrupting the micelle structure. Comparative studies with DKP solution and PSC commercial oral suspension (Noxafil^® 40 mg/mL) showed that the produced micelle-loaded nanofibers provided sustained release and significantly increased ex vivo ocular permeation and penetration. In vitro antifungal activity tests demonstrated efficacy against Candida albicans, and HET-CAM toxicity tests showed that the micelle-loaded nanofibers were non-irritating and suitable for ocular application. Overall, the micelle-loaded electrospun nanofiber ocular inserts developed in this study represent a promising platform for combined antifungal and anti-inflammatory ocular therapy. Full article

Oral fungal infections resulting from non-albicans Candida species and new opportunistic yeasts are increasingly linked to antifungal resistance, especially in individuals with periodontal disease. Bioactive compounds may serve as potential alternatives; nevertheless, there is a paucity of research that has comprehensively assessed their antifungal and antibiofilm efficacy against clinically defined oral yeast isolates. This study aimed to (i) describe the variety and antifungal resistance profiles of oral yeasts isolated from women with various periodontal diseases; (ii) assess four ethanolic extracts of Aseer medicinal plants (Foeniculum vulgare, Solanum incanum, Forsskaolea tenacissima, and Abutilon pannosum) for their antifungal and antibiofilm properties; and (iii) correlate phytochemical composition determined by GC–MS with biological activity. Oral samples (saliva and subgingival plaque) were collected from 50 female participants with documented periodontal parameters. Fungal isolates were identified using morphological, biochemical (VITEK 2), and molecular (ITS rDNA sequencing) methods. Testing for antifungal susceptibility was performed according to CLSI guidelines. Plant extracts were evaluated for antifungal activity (disk diffusion, MIC, MFC), antibiofilm activity (crystal violet assay and light microscopy), and phytochemical profiling (GC–MS). Fungal growth was detected in 37 of 50 samples (74%), yielding six yeast species: Nakaseomyces glabratus (40.5%), Candida tropicalis (18.9%), C. parapsilosis (13.5%), Pichia kudriavzevii (10.8%), Rhodotorula mucilaginosa (8.1%), and Aureobasidium melanogenum (8.1%). N. glabratus demonstrated reduced susceptibility to fluconazole. A. pannosum and F. vulgare exhibited the strongest in vitro antifungal activity (inhibition zones up to 19.2 mm; MIC 0.19–0.78 mg/mL; MFC 0.39–1.56 mg/mL), significantly greater than F. tenacissima (p < 0.0001). Sub-MIC concentrations of A. pannosum reduced C. tropicalis biofilm biomass by 59.6%. GC–MS analysis identified methyl salicylate (20.3–40.2%) and cyclohexanol derivatives (8.0–23.2%) as major constituents. Antifungal activity showed a trend in relation to methyl salicylate content (R² = 0.78). However, because only four plant extracts were included, this relationship should be interpreted as a descriptive observation rather than a statistically testable association. Ethanolic extracts of Abutilon pannosum and Foeniculum vulgare demonstrated significant in vitro antifungal and antibiofilm activity against clinically relevant oral yeasts, including azole-tolerant Nakaseomyces glabratus. The observed trends between phytochemical composition and biological activity warrant further investigation into their potential as adjunct therapeutic agents for oral fungal infections. Further studies are required to confirm these results and see if they can be used in therapeutic settings. Full article

The non-albicans Candida species Candida tropicalis is an opportunistic fungal pathogen that forms a robust gel-like biofilm on polymeric prosthetic materials. These biofilms are embedded in an extracellular polymeric substance that retains large amounts of water, resulting in a hydrogel-like matrix that protects fungal cells, increases antifungal resistance, and contributes to the biofouling of these prosthetic materials. Biofouling is the unwanted colonization and accumulation of microbial communities on material surfaces, which alters their function and compromises clinical performance. Clinically, it is significant because it is linked to recurrent urinary tract infections, bloodstream infections, and persistent device-related infections, which often result in therapeutic failure and device malfunction. Polymers such as silicone elastomer, polypropylene, polystyrene, polyurethane, polyethylene, and polyvinyl chloride are widely used in catheters, surgical meshes, implants, and prostheses because of their durability, flexibility, and biocompatibility, yet their surface properties often encourage microbial adhesion and biofilm formation. This review emphasizes that the gel-like biofilm architecture of C. tropicalis underpins its persistence and resistance, while also highlighting promising antifungal strategies being developed to mitigate these infections. Notably, palmitic acid has been shown to disrupt mature biofilms by lowering ergosterol and inducing oxidative stress, whereas C-10 massoia lactone damages the extracellular matrix and suppresses hyphal growth. Drug repurposing approaches, such as combining minocycline with fluconazole, restore susceptibility in resistant isolates and demonstrate synergistic antibiofilm activity. Additionally, biomaterial-based interventions, such as chitosan coatings on silicone surfaces, significantly reduce fungal adhesion and biofilm formation. Together, these findings reflect a translational shift toward integrating natural products, repurposed drugs, and functionalized biomaterials into antifungal development. Understanding biofouling and these emerging strategies is crucial for developing effective control measures against C. tropicalis biofilms and for guiding the design of infection-resistant prosthetic devices. Full article

Candida albicans is currently considered one of the most significant fungal pathogens in cetaceans and pinnipeds and the spread of antifungal-resistant strains pose significant threats to animal health and One Health concerns. Although C. albicans is the most commonly detected species, non-albicans Candida (NAC) species, including C. tropicalis, C. parapsilosis and Nakaseomyces glabratus and the multidrug-resistant C. auris, have been recognized in captive dolphins. This review examines the clinical patterns observed in marine mammal taxa: cetaceans are most commonly vulnerable to respiratory and disseminated mycoses owing to their distinct anatomical characteristics, whereas mucocutaneous infections are the common manifestation in pinnipeds. Localized mucocutaneous infections may progress to fatal systemic disease, with mortality rates approaching 100% in severe cases, despite therapeutic treatment. The most important predisposing factors are immunosuppression, long-term antibiotic treatment, environmental stress factors, and the deterioration of water quality. Diagnostic methods are based on cytology, histopathology, culture, and molecular methods, and treatment is mostly composed of systemic azole antifungals although with high levels of therapeutic failure. Recent results showed that there are high levels of azole resistance in the isolates of marine mammals that had no history of exposure to antifungal agents, which points to the role of aquatic environments as sources of resistance genes. The lack of knowledge remains particularly evident in species-specific pharmacokinetics and the development of evidence-based treatment guidelines. These infections also have broader implications for ecosystem health surveillance and the protection of endangered marine mammal populations. The current review highlights the One Health approach with marine mammals being at the core of ocean health surveillance and identifies the potential for zoonotic transmission. Full article

Objectives: To quantitatively evaluate the inhibitory effects of commercially available probiotic formulations (Probien, Enterogermina, Reflor) applied as intracanal medicaments against mature dual-species biofilms of Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) using a qPCR-based in vitro root canal model, with calcium hydroxide included as the reference intracanal medicament for comparison. Materials and Methods: Root canal specimens containing mature dual-species biofilms were medicated with probiotic–poloxamer gel formulations (Probien, Enterogermina, or Reflor) or calcium hydroxide (reference inhibitory control); infected but untreated canals served as the non-inhibitory control, and sterile non-inoculated specimens were included to confirm procedural sterility. After a 7-day intracanal application period, microbial loads were quantified at baseline and post-treatment by qPCR, and results were expressed as delta cycle threshold (ΔCt), colony-forming equivalents (CFE/mL), and percentage reduction values. Results: A total of 78 specimens (n = 13 per group) were analyzed. No significant intergroup differences were found in E. faecalis ΔCt or reduction percentages (p > 0.05), indicating its persistence despite intracanal medication. For C. albicans, differences among groups were significant (p < 0.001). Calcium hydroxide showed the strongest antifungal effect, producing marked ΔCt and CFE reductions versus probiotic and positive control groups, whereas probiotic formulations displayed only limited antifungal activity and no measurable inhibition against E. faecalis. Conclusions: Under the conditions of this in vitro model, the tested commercially available probiotic formulations—originally developed for gastrointestinal use—did not demonstrate significant antimicrobial effects against mature E. faecalis–C. albicans biofilms. These findings should be interpreted in the context of the absence of probiotic formulations specifically designed for intracanal use and the distinct ecological characteristics of the root canal system, which represents a closed, low-oxygen environment dominated by hard-tissue surfaces. Rather than excluding the potential of probiotics in endodontics, the present results highlight the need for root canal–adapted probiotic strains and delivery strategies tailored to intracanal conditions. Clinical Relevance: This in vitro study provides experimental insight into the limitations of directly applying commercially available gastrointestinal probiotic formulations within the root canal system. The findings highlight the importance of developing root canal–specific probiotic strains and delivery strategies tailored to the unique ecological conditions of the intracanal environment, thereby informing future translational and experimental research in biological endodontics. Full article

Background: Fungemia caused by non-Candida yeasts is rare but represents an emerging clinical problem that remains less well recognized and studied. These organisms often exhibit intrinsic resistance or reduced susceptibility to commonly used empirical antifungal agents, such as fluconazole and echinocandins. This poses significant challenges for empirical antifungal therapy. Objectives: To describe the clinical characteristics, antifungal treatments, and outcomes of pediatric patients with bloodstream infections due to non-Candida yeasts and to summarize the antifungal susceptibility profiles of available isolates. Methods: This retrospective study reviewed all episodes of fungemia caused by non-Candida yeasts at a tertiary pediatric center between 1 January 2020 and 1 September 2025. Results: Of the 139 yeast-related fungemia episodes identified during the study period, five (3.6%) were caused by non-Candida yeasts: three by Trichosporon spp., one by Rhodotorula mucilaginosa, and one by Magnusiomyces clavatus (formerly Saprochaete clavatus). Two cases occurred as breakthrough infections under ongoing antifungal treatment. Empirical antifungal treatments most often included amphotericin B, fluconazole, or echinocandins. The median time to species-level identification after the first positive culture result was six days (range 4–7), highlighting a considerable delay that may critically affect clinical management. Overall mortality was 40%, while attributable mortality due to non-Candida fungemia was 20%. Conclusions: Non-Candida yeasts, although infrequent, represent clinically important pathogens in pediatric fungemia due to their potential resistance to standard empirical antifungal agents. Early species-level identification and awareness of expected susceptibility patterns are essential to guide appropriate initial therapy and improve outcomes. Full article