Follow the Path: Unveiling an Azole Resistant Candida parapsilosis Outbreak by FTIR Spectroscopy and STR Analysis

Abstract

Accurate identification and rapid genotyping of Candida parapsilosis, a significant opportunistic pathogen in healthcare settings, is crucial for managing outbreaks, timely intervention, and effective infection control measures. This study includes 24 clinical samples and 2 positive environmental surveillance swabs collected during a fluconazole-resistant Candida parapsilosis outbreak at the Tuscany Rehabilitation Clinic (Clinica di Riabilitazione Toscana, CRT), located in the province of Arezzo, Italy. Fourier-transform infrared (FTIR) spectroscopy, genetic sequencing of the ERG11 gene, and short tandem repeat (STR) analysis was applied to track the fluconazole-resistant C. parapsilosis outbreak at the CRT facility. FTIR analysis clustered the isolates into two major groups, correlating with resistance-associated ERG11 mutations (Y132F and R398I), azole resistance levels, and year of isolation. The combined use of FTIR spectroscopy and STR typing provided a comprehensive approach to identify and track fluconazole-resistant C. parapsilosis isolates, which identified specific clusters of genetically similar isolates. By comparison with feasible molecular techniques, we conclude that FTIR spectroscopy applied in real time can inform targeted infection control strategies and aid in the effective management of nosocomial infections.