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

Abstract

Candidemia is the fourth most common healthcare-related bloodstream infection. In recent years, incidence rates of Candida parapsilosis have been on the rise, with differences in prevalence and antifungal susceptibility between countries. The aim of the present study was to evaluate temporal changes in prevalence and antifungal susceptibility of C. parapsilosis among other species causing candidemia. All candidemia episodes from January 2015 to August 2022 were evaluated in order to depict time trends in prevalence of C. parapsilosis sensu stricto among all Candida species recovered from blood cultures as well as fluconazole- and voriconazole-non-susceptibility rates. Secondary analyses evaluated time trends in prevalence and antifungal non-susceptibility according to clinical settings. The overall prevalence of C. parapsilosis was observed to increase compared to the prevalence of other Candida species over time (p-trend = 0.0124). From 2019, the number of C. parapsilosis sensu stricto isolates surpassed C. albicans, without an increase in incidence rates. Overall rates of fluconazole- and voriconazole-non-susceptible C. parapsilosis sensu stricto were both 3/44 (6.8%) in 2015 and were 32/51 (62.7%) and 27/51 (52.9%), respectively, in 2022 (85% cross-non-susceptibility). The risk of detecting fluconazole- or voriconazole-non-susceptibility was found to be higher in C. parapsilosis compared to other Candida species (odds ratio (OR) = 1.60, 95% CI [1.170, 2.188], p-value < 0.0001 and OR = 12.867, 95% CI [6.934, 23.878], p-value < 0.0001, respectively). This is the first study to report C. parapsilosis sensu stricto as the most prevalent among Candida spp. isolated from blood cultures, with worrisome fluconazole- and voriconazole-non-susceptibility rates, unparalleled among European and North American geographical regions.

Guideline Adherence and Outcomes of Patients with Candidemia in Brazil

“…Despite the small size of our sample and the fact that it is a single-center study, this is the only Brazilian study to analyze guideline adherence and outcomes of patients with candidemia. Another limitation of this study was that we did not perform susceptibility tests for the strains, due to their non-availability, especially that of C. parapsilosis, which has gained increasing importance due to azole resistance [19].…”

Hospital distribution, seasonality, time trends and antifungal susceptibility profiles of all Aspergillus species isolated from clinical samples from 2015 to 2022 in a tertiary care hospital

“…isolates for which an antifungal susceptibility test was performed were included in the analysis. In order to avoid potential biases when considering multiple isolates from the same subjects, it was decided to consider only the first positive sample culture and associated antifungal susceptibility test over a time span of 30 days for each Aspergillus species detected as reported for other microorganisms [ 39 , 40 ], in order to avoid repetitions and alteration of results. Data regarding patients’ ID were not included in the dataset, so patients were anonymized, and each subject was identified with a specific code that had no relation with private patients’ information.…”

“…Extracted variables included: age, sex, clinical setting, biological sample, date of detection, and species of Aspergillus , date of identification, and antifungal compounds susceptibility test with punctual MICs. Due to the large span of clinical settings, that ranged between 30 to 40 clinical wards in the hospital during the 8-year study period, authors decided to recode clinical wards according to the branch of medical specialties as reported in other studies for other fungal pathogens in the following list: internal medicine, surgery, intensive care unit, and outpatient clinic [ 39 , 40 ]. Outpatient clinic was composed by the following day hospital and outpatient services: pneumology, infectious diseases, pediatrics and family medicine answering all clinical needs of patients that were not currently admitted to the hospital.…”

Changing Epidemiology of Clinical Isolates of Candida Species during the Coronavirus Disease 2019 Pandemic: Data Analysis from a Korean Tertiary Care Hospital for 6 Years (2017–2022)

“… a COVID-19 pre-pandemic period was designated from January 2017 to December 2019; b COVID-19 pandemic period was designated from January 2020 to December 2022; c Candida parapsilosis complex included Candida parapsilosis sensu stricto, Candida orthopsilosis , and Candida metapsilosis [ 14 ]; d Other Candida species included Candida haemulonii (n = 3), Vanrija humicola (n = 3), Diutina catenulata (n = 2), Yarrowia lipolytica (n = 1), Diutina rugosa (n = 1), Candida magnoliae (n = 1), unknown Candida species (n = 1). …”

“… a COVID-19 pre-pandemic period was designated from January 2017 to December 2019; b COVID-19 pandemic period was designated from January 2020 to December 2022; c Candida parapsilosis complex included Candida parapsilosis sensu stricto, Candida orthopsilosis , and Candida metapsilosis [ 14 ]. …”