| Summary: | In recent decades, an epidemiological shift has been observed from <i>Candida</i> infections to non-<i>albicans</i> species and resistance to azoles. We investigated the associated factors and molecular mechanisms of azole-resistant blood isolates of <i>C. tropicalis</i>. Full-length sequencing of the <i>ERG11</i> gene and quantitative real-time RT-PCR for the <i>ERG11</i>, <i>MDR1</i>, and <i>CDR1</i> 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. <i>ERG11</i> 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 <i>ERG11</i>, <i>MDR1</i>, and <i>CDR1</i> 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.
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