Candida parapsilosis Sensu Stricto Antifungal Resistance Mechanisms and Associated Epidemiology

Abstract

Fungal diseases cause millions of deaths per year worldwide. Antifungal resistance has become a matter of great concern in public health. In recent years rates of non-albicans species have risen dramatically. Candida parapsilosis is now reported to be the second most frequent species causing candidemia in several countries in Europe, Latin America, South Africa and Asia. Rates of acquired azole resistance are reaching a worrisome threshold from multiple reports as in vitro susceptibility testing is now starting also to explore tolerance and heteroresistance to antifungal compounds. With this review, the authors seek to evaluate known antifungal resistance mechanisms and their worldwide distribution in Candida species infections with a specific focus on C. parapsilosis.

Antimicrobial and Antifungal Action of Biogenic Silver Nanoparticles in Combination with Antibiotics and Fungicides, against Opportunistic Bacteria and Yeast

“…[7]. The other non-albicans Candida species are also of growing concern in hospital epidemiology [8]. For example, a wide range of antifungal drugs best knows Candida auris, first described in 2009, for its strong resistance.…”

“…This is manifested in the absence of in vitro growth inhibition, when the minimum inhibitory concentrations of the selected drug cease to effectively suppress colony growth. This may also be evidenced by the clinical deterioration of the patient's condition and the constant isolation of the pathogen from his clinical samples, despite the administration of an antifungal drug [8]. The two main factors in the development of clinical resistance are the ability of Candida spp.…”

“…The two main factors in the development of clinical resistance are the ability of Candida spp. to form a biofilm and reduce the concentration of the drug in the infected area, which allows some part of the yeast to survive, which acquire resistance [8]. In addition, the widespread use of antifungal drugs in the clinic and in agricultural conditions can serve as a possible selective force in creating a reservoir of Candida spp.…”

Paradigm Shift: Candida parapsilosis sensu stricto as the Most Prevalent Candida Species Isolated from Bloodstream Infections with Increasing Azole-Non-Susceptibility Rates: Trends from 2015–2022 Survey

“…Based on its capacity to form biofilm and its virulence factors [28], C. parapsilosis has been identified as a healthcare-associated pathogen, spreading via hand carriage and persisting in the hospital environment [26]. In recent years, another peculiar aspect of this microorganism has been pointed out by researchers regarding its antifungal susceptibility [29][30][31]. Indeed, parallel to the reported increase in rates and prevalence of C. parapsilosis from BSI among the above-mentioned geographic regions, another clinical phenomenon has been described: decreased susceptibility to echinocandin [32] and azole compounds [29,33].…”

“…Data from European surveys differ greatly from one country to another, with the highest rates of azole resistance reported in Italy, of 33% for fluconazole and 18.2% for voriconazole [15], and Turkey, where susceptibility to fluconazole in C. parapsilosis accounted for 49% of all isolates collected from 2013 to 2017 [7]. Thankfully, in this scenario, echinocandin resistance is still a limited phenomenon seldomly described, even if reports of resistant isolates along with tolerance and heteroresistance have been reported at increasing rates [30,37].…”