Prospective Multicenter Study of the Epidemiology, Molecular Identification, and Antifungal Susceptibility of Candida parapsilosis, Candida orthopsilosis, and Candida metapsilosis Isolated from Patients with Candidemia

Abstract

A 13-month prospective multicenter study including 44 hospitals was carried out to evaluate the epidemiology of Candida parapsilosis complex candidemia in Spain. Susceptibility to amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin was tested by the microdilution colorimetric method. A total of 364 C. parapsilosis complex isolates were identified by molecular methods: C. parapsilosis (90.7%), Candida orthopsilosis (8.2%), and Candida metapsilosis (1.1%). Most candidemias (C. parapsilosis, 76.4%; C. orthopsilosis, 70.0%; C. metapsilosis, 100%) were observed in adults. No C. orthopsilosis or C. metapsilosis candidemias occurred in neonates. C. parapsilosis was most frequent in adult intensive care unit (28.8%), surgery (20.9%), and internal medicine (19.7%) departments; and C. orthopsilosis was most frequent in hematology (28.6%), pediatrics (12.0%), and neonatology (11.5%) departments. The geographic distribution of C. orthopsilosis and C. metapsilosis was not uniform. According to CLSI clinical breakpoints, all C. orthopsilosis and C. metapsilosis isolates were susceptible to the nine agents tested. Resistance (MICs > 1 mg/liter) was observed only in C. parapsilosis: amphotericin B, posaconazole, itraconazole, and caspofungin (0.3% each), anidulafungin (1.9%), and micafungin (2.5%). Applying the new species-specific fluconazole and echinocandin breakpoints, the rates of resistance to fluconazole for C. parapsilosis and C. orthopsilosis increased to 4.8% and 0.3%, respectively; conversely, for C. parapsilosis they shifted from 1.9 to 0.6% (anidulafungin) and from 2.5 to 0.6% (micafungin). Our study confirms the different prevalence of C. parapsilosis complex candidemia among age groups: neither C. orthopsilosis nor C. metapsilosis was isolated from neonates; interestingly, C. metapsilosis was isolated only from adults and the elderly. The disparity in antifungal susceptibility among species could be important for therapy.

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

“…The majority of the patients analysed in this study were from the HSE and in this hospital the incidence was 28.6 % for C. orthopsilosis and 4.8 % for C. metapsilosis. These values are higher than those described in a multi-centre surveillance study conducted in Brazil between 2003 and 2004 (C. orthopsilosis was 9 % and C. metapsilosis was 3 %; Gonçalves et al, 2010), and those in a Spanish multi-centre study that reported 8.2 % of C. orthopsilosis and 1.1 % of C. metapsilosis (Cantó n et al, 2011). Our values are relatively similar to those recorded in a Spanish study in which 23.5 % of C. orthopsilosis and 2.1 % of C. metapsilosis were found (Garcia-Effron et al, 2012).…”

Molecular Characterization of Candida parapsilosis Species Complex in Niches of the Oral Cavity in a Cohort of Patients from Argentina with Different Oral and Dental Clinical Manifestations

“…Among the azole derivatives analyzed in this study, FLC and VRC showed high levels of efficacy, as a single strain derived from the tongue showed SDD and SI to these drugs, respectively. And the MIC 50 and MIC 90 of both drugs was similar to that reported by other authors [2,17,18].…”

Molecular identification and antifungal susceptibility profiles of Candida parapsilosis complex species isolated from culture collection of clinical samples

“…Caspofungin MICs were interpreted as follows: ≤2µg/mL, susceptible; 4µg/mL, intermediate; and ≥8µg/mL, resistant (11) (12) . Isolates with MICs of greater than 1µg/mL were considered resistant to AMB and POS, as suggested by Nguyen et al (13) and Cantón et al (3) .…”

“…Amplifi cation of the SADH gene followed by BanI restriction enzyme digestion has been used as a rapid and reliable method with high discriminative power for C. parapsilosis complex species (6) (19) (20) (21) . Data have shown that these three species exhibit different prevalence rates, virulence, and in vitro antifungal susceptibility (3) (10) (19) (22) (23) (24) . In vitro studies have also shown that C. parapsilosis sensu stricto is more pathogenic than C. orthopsilosis, which is, in turn, is more pathogenic than C. metapsilosis (25) .…”