A Brazilian Inter-Hospital Candidemia Outbreak Caused by Fluconazole-Resistant Candida parapsilosis in the COVID-19 Era

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Thomaz, Danilo Y. ; Del Negro, Gilda M. B. ; Ribeiro, Leidiane B. ; da Silva, Mirian ; Carvalho, Gabrielle O. M. H. ; Camargo, Carlos H. ; de Almeida, Joao N. ; Motta, Adriana L. ; Siciliano, Rinaldo F. ; Sejas, Odeli N. E. ; Rossi, Flavia ; Abdala, Edson ; Strabelli, Tania M. V. ; Benard, Gil

• Document type: Journal article
• Source: JOURNAL OF FUNGI; v. 8, n. 2, p. 8-pg., 2022-02-01.

Abstract

Horizontal transmission of fluconazole-resistant Candida parapsilosis (FRCP) through healthcare workers' hands has contributed to the occurrence of candidemia outbreaks worldwide. Since the first COVID-19 case in Brazil was detected in early 2020, hospitals have reinforced hand hygiene and disinfection practices to minimize SARS-CoV-2 contamination. However, a Brazilian cardiology center, which shares ICU patients with a cancer center under a FRCP outbreak since 2019, reported an increased FRCP candidemia incidence in May 2020. Therefore, the purpose of this study was to investigate an inter-hospital candidemia outbreak caused by FRCP isolates during the first year of the COVID-19 pandemic in Brazil. C. parapsilosis bloodstream isolates obtained from the cancer (n = 35) and cardiology (n = 30) centers in 2020 were submitted to microsatellite genotyping and fluconazole susceptibility testing. The ERG11 gene of all isolates from the cardiology center was sequenced and compared to the corresponding sequences of the FRCP genotype responsible for the cancer center outbreak in 2019. Unprecedentedly, most of the FRCP isolates from the cardiology center presented the same genetic profile and Erg11-Y132F mutation detected in the strain that has been causing the persistent outbreak in the cancer center, highlighting the uninterrupted horizontal transmission of clonal isolates in our hospitals during the COVID-19 pandemic. (AU)

• FAPESP's process: 18/19347-4 - Characterization of molecular mechanisms related to azoles resistance in Trichosporon asahii clinical isolates
• Grantee: João Nóbrega de Almeida Júnior
• Support Opportunities: Scholarships abroad - Research
• FAPESP's process: 18/15491-3 - Genetic diversity of Candida parapsilosis (sensu stricto): correlation of emerging clusters with susceptibility to antifungal drugs, biofilm formation and virulence of isolates obtained from Invasive Candidiasis in a tertiary-care hospital
• Grantee: Danilo Yamamoto Thomaz
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 21/00871-8 - Determination of the biofilm formation profile of fluconazole-resistant Candida parapsilosis isolates obtained from a hospital outbreak of candidemia
• Grantee: Leidiane Barbosa Ribeiro
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• FAPESP's process: 19/17851-0 - Genotyping by microsatellite analysis of Candida parapsilosis (sensu stricto) isolates obtained from cases of Invasive Candidiasis
• Grantee: Gabrielle Oliveira Marques Haddad Carvalho
• Support Opportunities: Scholarships in Brazil - Scientific Initiation