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Prevalence and Clonal Distribution of Azole-Resistant Candida parapsilosis Isolates Causing Bloodstream Infections in a Large Italian Hospital

  • Martini, Cecilia1
  • Torelli, Riccardo2
  • de Groot, Theun3
  • De Carolis, Elena2
  • Morandotti, Grazia Angela2
  • De Angelis, Giulia1
  • Posteraro, Brunella1, 4
  • Meis, Jacques F.3, 5, 6
  • Sanguinetti, Maurizio1, 2
  • 1 Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome , (Italy)
  • 2 Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome , (Italy)
  • 3 Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen , (Netherlands)
  • 4 Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome , (Italy)
  • 5 Centre of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, Nijmegen , (Netherlands)
  • 6 Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba , (Brazil)
Published Article
Frontiers in Cellular and Infection Microbiology
Frontiers Media SA
Publication Date
May 25, 2020
DOI: 10.3389/fcimb.2020.00232
PMID: 32523896
PMCID: PMC7261875
PubMed Central


The most prevalent cause of nosocomial bloodstream infection (BSI) among non- C. albicans Candida species, Candida parapsilosis , may not only be resistant to azole antifungal agents but also disseminate to vulnerable patients. In this survey of BSIs occurring at a large Italian hospital between May 2014 and May 2019, C. parapsilosis accounted for 28.5% (241/844) of all Candida isolates causing BSI episodes. The majority of episodes (151/844) occurred in medical wards. Across the 5 yearly periods, the rates of azole non-susceptibility were 11.8% (4/34), 17.8% (8/45), 28.6% (12/42), 32.8% (19/58), and 17.7% (11/62), respectively, using the Sensititre YeastOne® method. Among azole non-susceptible isolates (54/241; 22.4%), 49 were available for further investigation. Using the CLSI reference method, all 49 isolates were resistant to fluconazole and, except one (susceptible dose-dependent), to voriconazole. Forty (81.6%) isolates harbored the Erg11p Y132F substitution and nine (18.4%) isolates the Y132F in combination with the Erg11p R398I substitution. According to their genotypes, as defined using a microsatellite analysis based on six short tandem repeat markers, 87.7% of isolates (43/49) grouped in two major clusters (II and III), whereas 4.1% of isolates (2/49) belonged to a separate cluster (I). Interestingly, all the isolates from cluster II harbored the Y132F substitution, and those from cluster III harbored both Y132F and R398I substitutions. Of 56 non-Italian isolates included as controls, two Indian isolates with the Y132F substitution had a genotype clearly differing from that of the isolates from clusters II and I. In conclusion, these findings show the dominance of clonal Y132F isolates in our hospital and suggest detection of the Y132F substitution as helpful tool to prevent transmission among hospitalized patients at risk of BSI.

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