Fig. 3: Geographic variations of C. tropicalis MLST clades, their association with azole resistance, and related temporal trends.

a Geographic variations of MLST clades across different continents. GB global, AS Asia, EU Europe, OC Oceania, NA North America, OT other continents. b The overall fluconazole (FLU)-resistant (R), susceptible-dose-dependent (SDD) and susceptible (S) rates of clade 4 and clade 5 isolates vs strains from other phylogenetic populations. c Comparison of fluconazole-resistance rates across different continents. Resistance rates are presented by bar plots, and the error bars indicated 95% confidence intervals, with p-values determined using two-sided Fisher exact test with Bonferroni correction; *adjust p-values < 0.05; ***adjust p-values < 0.001. In all, as MLST clade 4 and clade 5 isolates were more prevalent in Asia, and these two clades exhibited notably decreased azole susceptibly, the azole-resistance rate was significantly higher in Asia than in North America (p = 0.016), Europe (p < 0.001) and Oceania (p < 0.001). d Proportion of clade 4 isolates among fluconazole-resistant isolates in Asia-Pacific regions. CN China’s mainland, TW Taiwan China, TH Thailand, SG Singapore, IN India, JP Japan, AU Australia. e Proportion of clade 4 and clade 5 isolates among fluconazole-resistant strains over time. Clearly, clade 5 emerged earlier and became predominant from 1999 to 2008, but the major azole-resistant population quickly shifted to clade 4 after 2009.