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Background   Candida tropicalis  ( C. tropicalis ) is an important opportunistic pathogenic  Candida  species that can cause nosocomial infection. In this study, we analyzed the distribution and drug susceptibility of  C. tropicalis  and the relationship between ERG11 and UPC2 expression and resistance to azole antifungal agents.    Methods   C. tropicalis  was cultured and identified by Sabouraud Agar Medium, CHROM Agar Candida and ATB tests (Bio-Mérieux, France). Total RNA was extracted from the collected strains, and the ERG11 and UPC2 mRNA expression levels were analyzed by quantitative real-time PCR.    Results  In total, 2872 clinical isolates of  Candida , including 319 strains of  C. tropicalis , were analyzed herein; they were mainly obtained from the Departments of Respiratory Medicine and ICU. The strains were predominantly isolated from airway secretion samples, and the detection trend in four years was mainly related to the type of department and specimens. The resistance rates of  C. tropicalis  to fluconazole, itraconazole and voriconazole had been increasing year by year. The mRNA expression levels of ERG11 and UPC2 in the fluconazole-resistant group were significantly higher than they were in the susceptible group. In addition, there was a significant positive linear correlation between these two genes in the fluconazole-resistant group.    Conclusions  Overexpression of the ERG11 and UPC2 genes in  C. tropicalis  could increase resistance to azole antifungal drugs. The routine testing for ERG11 and UPC2 in high-risk patients in key departments would provide a theoretical basis for the rational application of azole antifungal drugs.

Candida tropicalis distribution and drug resistance is correlated with ERG11 and UPC2 expression