Potential association of specific Candida parapsilosis genotypes, bloodstream infections and colonization of health workers' hands

Abstract

Fungal nosocomial infections continue to be a serious problem among hospitalized patients, decreasing quality of life and adding millions of euros to healthcare costs. The aim of this study was to describe the pattern of fungi associated with the hands of healthcare workers and to genotype Candida parapsilosis isolates in order to understand whether their high clinical prevalence stems from endemic nosocomial genotypes or from the real emergence of epidemiologically-unrelated strains. Approximately 39% (50/129) of healthcare workers were positive for yeasts and among 77 different fungal isolates recovered, C. parapsilosis was the most frequent (44/77; 57%). Twenty-seven diverse genotypes were obtained by microsatellite analysis of 42 selected blood and hand isolates. Most of the isolates from hands showed a new, unrelated, genotype, whereas a particular group of closely related genotypes prevailed in blood samples. Some of the latter genotypes were also found on the hands of healthcare workers, indicating a persistence of these clones within our hospital. C. parapsilosis genotypes from the hands were much more heterogeneous than clinical ones, thus reflecting a high genetic diversity among isolates, which is notably unusual and unexpected for this species.

Different scenarios for Candida parapsilosis fungaemia reveal high numbers of mixed C. parapsilosis and Candida orthopsilosis infections

“…However, more recently some European regions, including southern L. S. Barbedo and others Italy, have reported bloodstream incidences for C. parapsilosis infection of around 60 %, similar to those observed in Brazil (Delfino et al, 2014). Moreover, the distribution of C. orthopsilosis and C. metapsilosis as agents of invasive infections has marked variability.…”

Changing epidemiology of candidaemia: Increase in fluconazole‐resistant Candida parapsilosis

“…This hypothesis is supported by the microbiological tests that confirmed clonal similarity of isolates tested and high rate of fluconazole resistance which is uncharacteristic for this species (<5%) . A possible horizontal yeast transmission by healthcare personnel, as already reported by Delfino et al, could not be excluded. Indeed, outbreaks due to C parapsilosis have been reported, especially in neonatal setting, and in such cases reduced sensitivity and cross‐resistance to triazoles was found .…”

Candidaemia in a tertiary care academic hospital in Italy. The impact of C. parapsilosis complex on the species distribution and antifungal susceptibility

“…However, C. parapsilosis complex had a higher isolation rate than C. albicans in the ICU settings of our hospital settings. Delfino et al [25] showed that some C. parapsilosis genotypes recovered from the hands of healthcare workers were also found in blood samples. It could be that the high number of BSIs caused by C. parapsilosis complex might be, at least in part, attributable to the horizontal transmission of this species by hospital staff.…”