Genotypic Diversity of Candida parapsilosis Complex in Invasive Candidiasis at a Pediatric Tertiary Hospital: A 5-Year Retrospective Study

Rodrigues, Luiza Souza; Siqueira, Adriele C.; Spalanzani, Regiane N.; Vasconcelos, Thaís Muniz; Sestren, Bianca; Bispo, Saloe P.; Abreu, Renata B. V.; Kraft, Letícia; Ricieri, Marinei Campos; Motta, Fábio Araújo; Dalla-Costa, Líbera Maria

doi:10.3390/jof8121280

Cited by 5 publications

(3 citation statements)

References 38 publications

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“…The diversity of the genotypes detected in this study points to the possibility of numerous causes contributing to the occurrence of C. parapsilosis infections in Japan. In line with our findings, two recent studies in Brazil identified different C. parapsilosis genotypes among pediatric patients [31,32], but their results also confirmed whether these genotypes are phylogenetically related or not. Moreover, highly related genotypes have caused outbreaks of C. parapsilosis candidemia in neonatal intensive care units in the USA [33].…”

Section: Discussionsupporting

confidence: 92%

Antifungal Resistance and Genotyping of Clinical Candida parapsilosis Complex in Japan

Khalifa,

Watanabe,

Kamei

2023

JoF

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Non-albicans Candida infections have recently gained worldwide attention due to their intrinsic resistance to different antifungal agents and the limited therapeutic options for treating them. Although the Candida parapsilosis complex is reported to be the second or third most prevalent Candida spp., little information is available on the prevalence of antifungal resistance along with genotyping of the C. parapsilosis complex. In this study, we aimed to evaluate the prevalence of antifungal resistance, the genetic basis of such resistance, and the genotyping of C. parapsilosis complex isolates that were recovered from hospitalized patients in Japan from 2005 to 2019. Our results indicated that, with the exception of one single C. metapsilosis isolate that was dose-dependently susceptible to fluconazole, all other isolates were susceptible or showed wild phenotypes to all tested antifungals, including azoles, echinocandins, amphotericin B, and flucytosine. Molecular analyses for azole and echinocandin resistance via evaluating ERG11 mutation and FKS1 hotspot one (HS1) and hotspot two (HS2) mutations, respectively, confirmed the phenotypic results. Genotyping of our isolates confirmed that they belong to 53 different but closely related genotypes, with a similarity percentage of up to 90%. Our results are of significant concern, since understanding the genetic basis of echinocandin resistance in the C. parapsilosis complex as well their genotyping is essential for directing targeted therapy, identifying probable infection sources, and developing strategies for overcoming epidemic spread.

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Section: Discussionsupporting

confidence: 92%

Antifungal Resistance and Genotyping of Clinical Candida parapsilosis Complex in Japan

Khalifa,

Watanabe,

Kamei

2023

JoF

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“…Using STR (hereafter used instead of microsatellite), studies ( 4 , 6 , 8 , 16 – 18 ) have shown that outbreak or persistent clonal isolates of C. parapsilosis clustered according to being resistant or susceptible to fluconazole and that fluconazole-resistant isolates harbored the same mutation (i.e., Y132F) in the ERG11 -encoded azole-target fungal enzyme ( 2 ). No link between the presence of Erg11p mutation and STR-based clustering of C. parapsilosis isolates was shown elsewhere ( 11 , 22 ), suggesting that STR may not be discriminatory enough.…”

Section: Introductionmentioning

confidence: 91%

“…Together with some other Candida species (including C. albicans ), Candida parapsilosis sensu stricto , which belongs to the C. parapsilosis species complex (also including C. orthopsilosis and C. metapsilosis ), remains a leading cause of nosocomial bloodstream infection (BSI) worldwide ( 1 ). This species (hereafter referred to as C. parapsilosis ) continues to be dominant and/or associated with neonatal or pediatric hospital settings ( 2 ), particularly in Southern Europe (i.e., Mediterranean regions), Asia, and South America ( 3 – 11 ). Due to the propensity to form biofilm on medically implanted devices (including intravascular catheters) and the persistence in hospital environments ( 12 ), C. parapsilosis is increasingly involved in nosocomial outbreaks ( 13 – 19 ).…”

Section: Introductionmentioning

confidence: 99%

The Fourier-transform infrared spectroscopy-based method as a new typing tool for Candida parapsilosis clinical isolates

De Carolis,

Posteraro,

Falasca

et al. 2023

Microbiol Spectr

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The Fourier-transform infrared spectroscopy-based IR Biotyper is a straightforward typing tool for bacterial species, but its use with Candida species is limited. We applied IR Biotyper to Candida parapsilosis , a common cause of nosocomial bloodstream infection (BSI), which is aggravated by the intra-hospital spread of fluconazole-resistant isolates. Of 59 C . parapsilosis isolates studied, n = 56 (48 fluconazole-resistant and 8 fluconazole-susceptible) and n = 3 (2 fluconazole-resistant and 1 fluconazole-susceptible) isolates, respectively, had been recovered from BSI episodes in 2 spatially distant Italian hospitals. The latter isolates served as an outgroup. Of fluconazole-resistant isolates, n = 40 (including one outgroup) harbored the Y132F mutation alone and n = 10 (including one outgroup) harbored both Y132F and R398I mutations in the ERG11 -encoded azole-target enzyme. Using a microsatellite typing method, which relies on the amplification of genomic short tandem repeats (STR), two major clusters were obtained based on the mutation(s) (Y132F or Y132F/R398I) present in the isolates. Regarding IR Biotyper, each isolate was analyzed in quintuplicate using an automatic (i.e., proposed by the manufacturer’s software) or tentative (i.e., proposed by us) cutoff value. In the first case, four clusters were identified, with clusters I and II formed by Y132F or Y132F/R398I isolates, respectively. In the second case, six subclusters (derived by the split of clusters I and II) were identified. This allowed to separate the outgroup isolates from other isolates and to increase the IR Biotyper typeability. The agreement of IR Biotyper with STR ranged from 47% to 74%, depending on type of cutoff value used in the analysis. IMPORTANCE Establishing relatedness between clinical isolates of Candida parapsilosis is important for implementing rapid measures to control and prevent nosocomial transmission of this Candida species. We evaluated the FTIR-based IR Biotyper, a new typing method in the Candida field, using a collection of fluconazole-resistant C. parapsilosis isolates supposed to be genetically related due to the presence of the Y132F mutation. We showed that IR Biotyper was discriminatory but not as much as the STR method, which is still considered the method of choice. Further studies on larger series of C. parapsilosis isolates or closely related Candida species will be necessary to confirm and/or extend the results from this study.

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Invasive candidiasis in a pediatric tertiary hospital: Epidemiology, antifungal susceptibility, and mortality rates

Rodrigues,

Siqueira,

Vasconcelos

et al. 2024

Medical Mycology

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Invasive infections caused by non-albicans Candida are increasing worldwide. However, there is still a lack of information on invasive candidiasis (IC) in the pediatric setting, including susceptibility profiles and clonal studies. We investigated the clinical, epidemiologic, and laboratory characteristics of IC, possible changes in antifungal susceptibility profiles over time, and the occurrence of clonality in our tertiary children's hospital. We analyzed 123 non-duplicate Candida isolates from sterile sites of pediatric patients in a tertiary hospital in southern Brazil, between 2016 and 2021. Data on demographics, comorbidities, and clinical outcomes were collected. Candida species distribution, antifungal susceptibility profiles, biofilm production, and molecular epidemiology of isolates were assessed using reference methods. The range of IC incidence was 0.88-1.55 cases per 1000 hospitalized patients/year, and the IC-related mortality rate was 20.3%. Of the total IC cases, 42.3% were in patients aged < 13 months. Mechanical ventilation, parenteral nutrition, and intensive care unit (ICU) admission were common in this group. In addition, ICU admission was identified as a risk factor for IC-related mortality. The main site of Candida spp. isolation was blood, and non-albicans Candida species were predominant (70.8%). No significant clonal spread was observed among isolates of the three most commonly isolated species, and 99.1% of all isolates were biofilm producers. The incidence of IC and strain susceptibility patterns may vary over time, geographically, and among different populations. Non-albicans Candida species were predominant in this study. Notably, clonal expansion and emergence of antifungal drug resistance were not observed in our pediatric setting.

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Genotypic Diversity of Candida parapsilosis Complex in Invasive Candidiasis at a Pediatric Tertiary Hospital: A 5-Year Retrospective Study

Cited by 5 publications

References 38 publications

Antifungal Resistance and Genotyping of Clinical Candida parapsilosis Complex in Japan

Antifungal Resistance and Genotyping of Clinical Candida parapsilosis Complex in Japan

The Fourier-transform infrared spectroscopy-based method as a new typing tool for Candida parapsilosis clinical isolates

Invasive candidiasis in a pediatric tertiary hospital: Epidemiology, antifungal susceptibility, and mortality rates

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