Liver transplant recipients are at risk of invasive fungal infections, especially candidiasis. Echinocandin is recommended as prophylactic treatment but is increasingly associated with resistance. Our aim was to assess echinocandin drug resistance in Candida spp. isolated from liver transplant recipients treated with this antifungal class. For this, all liver-transplanted patients in a University Hospital (Créteil, France) between January and June of 2013 and 2015 were included. Susceptibilities of Candida isolates to echinocandins were tested by Etest and the EUCAST reference method. Isolates were analyzed by FKS sequencing and genotyped based on microsatellites or multilocus sequence typing (MLST) profiles. Ninety-four patients were included, and 39 patients were colonized or infected and treated with echinocandin. Echinocandin resistance appeared in 3 (8%) of the treated patients within 1 month of treatment. One patient was colonized by resistant Candida glabrata, one by resistant Candida dubliniensis, and one by resistant Candida albicans. Molecular analysis found three mutations in FKS2 HS1 (F659S, S663A, and D666E) for C. glabrata and one mutation in FKS1 HS1 (S645P) for C. dubliniensis and C. albicans. Susceptible and resistant isolates belonged to the same genotype. To our knowledge, this is the first study on echinocandin resistance in Candida spp. in a liver transplant population. Most resistant isolates were found around/in digestive sites, perhaps due to lower diffusion of echinocandin in these sites. This work documents the risk of emergence of resistance to echinocandin, even after short-term treatment.

Extra-european studies reported high rates of multi-drug resistant bacteria colonization of healthcare workers' mobile phones in intensive care unit. The purpose was to assess the prevalence of bacterial colonization of healthcare workers' mobile phones in a French intensive care unit and the efficacy of a sanitization product.We designed a prospective monocentric study in a 15-bed intensive care unit in a 300-bed private hospital. Bacterial colonization was assessed in 56 healthcare workers' mobile phones immediately before and after 5 min of sanitization with bactericidal wipes. Control were 42 administrative staff' mobile phones.All mobile phones were colonized in both groups; at least with coagulase negative Staphylococcus. The number of different bacterial species per phone was higher in healthcare workers' (2.45 ± 1.34 vs. 1.81 ± 0.74, p=0.02). Colonization with pathogens did not differ significantly across healthcare workers' phones and controls' (39.3% vs. 28.6%, p=0.37).Staphylococcus aureus was the most common pathogen in both groups (19.6% and 11.9%, p=0.41). Only 1 healthcare workers' mobile phone was colonized by Methicillin-Resistant Staphylococcus aureus and no other multi-drug resistant bacteria was detected. No covariate was associated with pathogens colonization. After sanitization, only 8.9% of mobile phones were sterilized yet colonization with pathogen bacteria decreased (21.4% vs. 39.3%, p=0.002) as well as the number of CFUs/mL (367 ± 404 vs. 733 ± 356, p<0.001)In conclusion, colonization of intensive care unit healthcare workers' and administrative staff's mobile phones is similar. Colonization is rare with multi-drug resistant bacteria but frequent with pathogens. Sanitization with bactericidal wipes is incompletely effective. Specific sanitization protocol and recommendations regarding healthcare workers' mobile phones management in intensive care unit should be developed and good hand hygiene after touching mobile phones should be kept in mind to prevent cross-infections.

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