The Risk Factors and Mechanisms of Azole Resistance of Blood Isolates in Thailand: A Retrospective Cohort Study.

In recent decades, an epidemiological shift has been observed from infections to non- species and resistance to azoles. We investigated the associated factors and molecular mechanisms of azole-resistant blood isolates of . Full-length sequencing of the gene and quantitative real-time RT-PCR for the , , and genes were performed. Male sex (odds ratio, 0.38), leukemia (odds ratio 3.15), and recent administration of azole (odds ratio 10.56) were associated with isolates resistant to azole. mutations were found in 83% of resistant isolates, with A395T as the most common mutation (53%). There were no statistically significant differences in the expression of the , , and genes between the groups resistant and susceptible to azole. The prevalence of azole-resistant isolates was higher than the usage of antifungal drugs, suggesting the possibility of environmental transmission in the healthcare setting. The unknown mechanism of the other 17% of the resistant isolates remains to be further investigated.