Prevalence and Clonal Distribution of Azole-Resistant Candida parapsilosis Isolates Causing Bloodstream Infections in a Large Italian Hospital
Prevalence and Clonal Distribution of Azole-Resistant Candida parapsilosis Isolates Causing Bloodstream Infections in a Large Italian Hospital
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DOI：
10.3389/fcimb.2020.00232
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发表时间：
2020-05-25
影响因子：
5.7
通讯作者：
Sanguinetti, Maurizio
中科院分区：
文献类型：
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作者：
Martini, Cecilia;Torelli, Riccardo;Sanguinetti, Maurizio
医院内血流感染（BSI）的最常见原因是非C。近平滑念珠菌不仅对唑类抗真菌药物耐药，而且还可传播给易感患者。在这项对2014年5月至2019年5月期间在意大利一家大型医院发生的BSI的调查中，C.近平滑念珠菌占所有引起BSI的念珠菌分离株的28.5%（241/844）。大多数事件（151/844）发生在内科病房。在5年期间，使用Sensititre YeastOne（R）方法，唑类药物不敏感率分别为11.8%（4/34）、17.8%（8/45）、28.6%（12/42）、32.8%（19/58）和17.7%（11/62）。在唑类非敏感菌株中（54/241; 22.4%），49株可用于进一步调查。使用CLSI参考方法，所有49株分离株均对氟康唑耐药，除1株（敏感剂量依赖性）外，均对伏立康唑耐药。40株（81.6%）分离株携带Erg 11 p Y132 F置换，9株（18.4%）分离株携带Y132 F和Erg 11 p R398 I置换。根据它们的基因型，如使用基于六个短串联重复标记的微卫星分析所定义的，87.7%的分离株（43/49）分为两个主要的集群（II和III），而4.1%的分离株（2/49）属于一个单独的集群（I）。有趣的是，来自聚类II的所有分离株都具有Y132 F置换，而来自聚类III的分离株具有Y132 F和R398 I置换。在作为对照的56个非意大利分离株中，两个Y132 F置换的印度分离株的基因型明显不同于聚类II和I的分离株。总之，这些研究结果表明，克隆Y132 F分离株在我们医院的优势，并建议检测Y132 F替代作为有用的工具，以防止在BSI的风险住院患者之间的传播。
The most prevalent cause of nosocomial bloodstream infection (BSI) among non-C. albicans Candida species, Candida parapsilosis, may not only be resistant to azole antifungal agents but also disseminate to vulnerable patients. In this survey of BSIs occurring at a large Italian hospital between May 2014 and May 2019, C. parapsilosis accounted for 28.5% (241/844) of all Candida isolates causing BSI episodes. The majority of episodes (151/844) occurred in medical wards. Across the 5 yearly periods, the rates of azole non-susceptibility were 11.8% (4/34), 17.8% (8/45), 28.6% (12/42), 32.8% (19/58), and 17.7% (11/62), respectively, using the Sensititre YeastOne (R) method. Among azole non-susceptible isolates (54/241; 22.4%), 49 were available for further investigation. Using the CLSI reference method, all 49 isolates were resistant to fluconazole and, except one (susceptible dose-dependent), to voriconazole. Forty (81.6%) isolates harbored the Erg11p Y132F substitution and nine (18.4%) isolates the Y132F in combination with the Erg11p R398I substitution. According to their genotypes, as defined using a microsatellite analysis based on six short tandem repeat markers, 87.7% of isolates (43/49) grouped in two major clusters (II and III), whereas 4.1% of isolates (2/49) belonged to a separate cluster (I). Interestingly, all the isolates from cluster II harbored the Y132F substitution, and those from cluster III harbored both Y132F and R398I substitutions. Of 56 non-Italian isolates included as controls, two Indian isolates with the Y132F substitution had a genotype clearly differing from that of the isolates from clusters II and I. In conclusion, these findings show the dominance of clonal Y132F isolates in our hospital and suggest detection of the Y132F substitution as helpful tool to prevent transmission among hospitalized patients at risk of BSI.