1. Global Emergence of Resistance to Fluconazole and Voriconazole in Candida parapsilosis in Tertiary Hospitals in Spain During the COVID-19 Pandemic
- Author
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Trevijano-Contador, Nuria, Torres-Cano, Alba, Carballo-González, Cristina, Puig-Asensio, Mireia, Martin-Gomez, M. Teresa, Jiménez-Martínez, Emilio, Romero, Daniel, Nuvials, Xavier, Olmos-Arenas, Roberto, Moretó-Castellsagué, María Clara, Fernández-Delgado, Lucía, Rodríguez-Sevilla, Graciela, Aguilar-Sánchez, María-Mercedes, Ayats-Ardite, Josefina, Ardanuy-Tisaire, Carmen, Sanchez-Romero, Isabel, Muñoz-Algarra, María, Merino-Amador, Paloma, González-Romo, Fernando, Megías-Lobón, Gregoria, García-Campos, Jose Angel, Mantecón-Vallejo, María Ángeles, Alcoceba, Eva, Escribano, Pilar, Guinea, Jesús, Durán-Valle, Maria Teresa, Fraile-Torres, Arturo, Roiz-Mesones, María Pía, Lara-Plaza, Isabel, de Ayala, Ana Pérez, Simón-Sacristán, María, Collazos-Blanco, Ana, Nebreda-Mayoral, Teresa, March-Roselló, Gabriel, Alcázar-Fuoli, Laura, Zaragoza, Óscar, Universitat Autònoma de Barcelona, Institut Català de la Salut, [Trevijano-Contador N, Torres-Cano A, Carballo-González C] Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III. Carretera Majadahonda-Pozuelo, Madrid, Spain. [Puig-Asensio M] Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain. Center for Biomedical Research in Network in Infectious Diseases (CIBERINFEC, CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain. [Martín-Gómez MT] Servei de Microbiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Jiménez-Martínez E] Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain. [Romero D] Servei de Microbiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Nuvials FX] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain, Vall d'Hebron Barcelona Hospital Campus, Ministerio de Ciencia e Innovación (España), Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red - CIBERINFEC (Enfermedades Infecciosas), and Centro de Investigación Biomédica en Red - CIBERES (Enfermedades Respiratorias)
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Candida parapsilosis ,Càndida ,Outbreaks ,Candidiasis ,Eukaryota::Fungi::Ascomycota::Saccharomycetales::Candida::Candida parapsilosis [ORGANISMS] ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,Antifungal resistance ,Infectious Diseases ,fenómenos microbiológicos::farmacorresistencia microbiana::farmacorresistencia fúngica [FENÓMENOS Y PROCESOS] ,Oncology ,Eukaryota::hongos::Ascomycota::Saccharomycetales::Candida::Candida parapsilosis [ORGANISMOS] ,Drug resistance ,Candidiasi ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,Pandèmia de COVID-19, 2020 ,Voriconazole ,Microbiological Phenomena::Drug Resistance, Microbial::Drug Resistance, Fungal [PHENOMENA AND PROCESSES] ,Fluconazole ,Resistència als medicaments - Abstract
Candida parapsilosis; Antifungal resistance; Outbreaks Candida parapsilosis; Resistencia antifúngica; Brotes Candida parapsilosis; Resistència antifúngica; Brots Background Candida parapsilosis is a frequent cause of candidemia worldwide. Its incidence is associated with the use of medical implants, such as central venous catheters or parenteral nutrition. This species has reduced susceptibility to echinocandins, and it is susceptible to polyenes and azoles. Multiple outbreaks caused by fluconazole-nonsusceptible strains have been reported recently. A similar trend has been observed among the C. parapsilosis isolates received in the last 2 years at the Spanish Mycology Reference Laboratory. Methods Yeast were identified by molecular biology, and antifungal susceptibility testing was performed using the European Committee on Antimicrobial Susceptibility Testing protocol. The ERG11 gene was sequenced to identify resistance mechanisms, and strain typing was carried out by microsatellite analysis. Results We examined the susceptibility profile of 1315 C. parapsilosis isolates available at our reference laboratory between 2000 and 2021, noticing an increase in the number of isolates with acquired resistance to fluconazole, and voriconazole has increased in at least 8 different Spanish hospitals in 2020–2021. From 121 recorded clones, 3 were identified as the most prevalent in Spain (clone 10 in Catalonia and clone 96 in Castilla-Leon and Madrid, whereas clone 67 was found in 2 geographically unrelated regions, Cantabria and the Balearic Islands). Conclusions Our data suggest that concurrently with the coronavirus disease 2019 pandemic, a selection of fluconazole-resistant C. parapsilosis isolates has occurred in Spain, and the expansion of specific clones has been noted across centers. Further research is needed to determine the factors that underlie the successful expansion of these clones and their potential genetic relatedness. O.Z. was funded by grants SAF2017–86912-R and PID2020–114546RB-I00 from the Spanish Ministry for Science and Innovation. This work was also funded by the National Centre for Microbiology (Instituto de Salud Carlos III) through the Surveillance Program of Antifungal Resistance and the Center for Biomedical Research in Network of Infectious Diseases CIBERINFECTCB21/13/00105 (O.Z. and L.A.F.), CIBERINFEC-CB21/13/00009 (M.P.-A.), CIBERES-CB06/06/0037 (C.A.-T.), and CIBERES-CB06/06/0058 (J.G). L.A.-F. was supported by Fondo de Investigación Sanitaria (MPY 117/18 and MPY 305/20). We thank Dr. David Campany Herrero (Vall d’Hebron Hospital), Noelia Garrido Peño (Móstoles Hospital), David Gómez Gómez y Aitziber Illaro Uranga (Marqués de Valdecilla Hospital), María Ángeles Machín Morón (Burgos Hospital), Jose Manuel Caro Teller (Doce de Octubre Hospital), Marina Calvo (Puerta de Hierro Hospital), and Ariadna Padulles (Bellvitge Hospital) for providing the data on antifungal consumption from their hospitals. We also thank Ángel Zaballos and Pilar Jiménez from the Genomics Core Facility from Instituto de Salud Carlos III for their technical help with the microsatellite analysis technique.
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- 2022