Study Sites and Subject Selection

All C. albicans strains were collected from positive hemocultures from a diagnostic microbiology laboratory of the Department of Microbiology, Siriraj Hospital, between April 2016 and November 2017. This study was approved by the Siriraj Institutional Review Board, no. SI 091/2016. Informed consent was not required in this work. All strains, collected from the same patients, were considered sequentially collected, as blood samples were taken from different body sites at different time points. Forty-six strains from 37 individual candidemia patients were collected. Available patient records were retrieved from the hospital registry. A healthcare-associated infection was defined as an onset of candidemia symptoms and/or signs after 48 h of admission. As the hospital is a tertiary care referral center, patient origins varied. Most cases (81.25%; 26 of the 32 available patient records) were from central Thailand; 6.25, 6.25, and 6.25% of cases were from Eastern, Northeastern, and Western Thailand, respectively. The case fatality rate was calculated as the ratio of patient deaths to all candidemia cases in this study. All strains were identified using CHROMagar Candida chromogenic media (Oxoid, United Kingdom) and RapID^TM YEAST PLUS System (Thermo Scientific, United States) followed by single-colony subculture on Sabouraud dextrose agar (SDA; Oxoid, United Kingdom) to prepare pure cultures before performing any further analysis.