Expect the unexpected: fungemia caused by uncommon Candida species in a Turkish University Hospital

Fungemia caused by uncommon Candida species (UCS) (other than C.albicans , C.glabrata , C.parapsilosis , C.tropicalis , C.krusei ) is a rare but emerging threat with their potential to exhibit reduced susceptibility or resistance to antifungal agents. We identified 25 patients with UCS fungemia (9 C.kefyr , 8 C.lusitaniae , 4 C.dubliniensis , 2 C.guilliermondii , 1 C.pelliculosa , 1 C.rugosa ) through January 2011 and August 2018. Echinocandins were the most common administered agents, followed by fluconazole. Overall mortality was 44%. Echinocandins and voriconazole showed sufficient activity against all tested isolates. High fluconazole MICs among C.guilliermondii , C.pelliculosa , and C.rugosa were determined. MIC value of C.pelliculosa was above the epidemiological cut-off proposed for fluconazole.